The purpose of the study was to determine whether applying highly recommended changes in the 2005 American Heart Association (AHA) Guidelines would improve outcomes after out-of-hospital cardiac ...arrest.
In 2005, AHA recommended multiple ways to improve circulation during cardiopulmonary resuscitation (CPR).
Conglomerate quality assurance data were analyzed during prospective implementation of the 2005 AHA Guidelines in five emergency medical services (EMS) systems. All EMS personnel were trained in the key new aspects of the 2005 AHA Guidelines, including use of an impedance threshold device. The primary outcome was survival to hospital discharge. Secondary outcomes were return of spontaneous circulation (ROSC), survival by initial cardiac arrest rhythm, and the cerebral performance category (CPC) score at hospital discharge.
There were 1,605 patients in the intervention group and 1,641 patients in the control group. Demographics, the rate of bystander CPR, and time from the 911 call for help to arrival of EMS personnel were similar between groups. Survival to hospital discharge was 10.1% in the control group versus 13.1% in the intervention group (P = .007). For patients with a presenting rhythm of ventricular fibrillation/ventricular tachycardia, survival to discharge was 20% in controls versus 32.3% in the intervention group (P <.001). Survival to discharge with a CPC classification of 1 or 2 was 33.3% (10/30) in the control versus 59.6% (31/52) in the intervention group (P = .038).
Compared with controls, patients with out-of-hospital cardiac arrest treated with a renewed emphasis on improved circulation during CPR had significantly higher neurologically intact hospital discharge rates.
Laser scalpel for solid organ surgery Durtschi, M B; Stothert, Jr, J C; Ashleman, B ...
The American journal of surgery
139, Številka:
5
Journal Article
Recenzirano
Hemostasis remains a major technical problem in surgery of the liver and spleen. A high power neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has been coupled with a fiberoptic delivery system ...and quartz blade designed to yield maximal hemostasis and minimal tissue injury. In a series of experiments we were unable to demonstrate a significant advantage of its use in partial hepatic lobectomy.
This study examined the difference between clinical impressions and autopsy findings in a group of patients dying on a university surgical service after blunt injury, penetrating injury, or thermal ...burns. Of 215 patients dying between the years 1984 and 1988, 212 were included in this study (autopsy rate, 98.6%). Major discrepancies in clinical diagnosis versus the anatomic diagnosis at autopsy were found to occur in approximately 30% of patients. The incidence of errors in diagnosis which may have impacted on survival in these groups of injured patients was quite low (5.1%). These data support the continued practice of obtaining autopsy in all patients dying from trauma. This information is clinically relevant, and, in today's atmosphere of quality assurance, absolutely necessary for a modern trauma center.
The finding of delayed hypersensitivity on skin testing has been used to predict the outcome following operations, traumas or severe illnesses and has been correlated with nutritional status in some ...reports. To test these hypotheses, we did weekly skin tests with a battery of four antigens on 98 high-risk patients referred to the nutritional support service. Anergy persisted or developed in 72 patients, whereas 26 patients remained or became reactive. These two groups were comparable in number of days in hospital, age and amount and duration of parenteral nutrition. Infectious complications (68 percent versus 23 percent, P<.001), sepsis (35 percent versus 12 percent, P<.01) and mortality (33 percent versus 0 percent, P<.001) were more prevalent in anergic than in reactive patients. There was no correlation between nitrogen balance studies and skin test results. In most instances conversion of skin test results occurred as a consequence of appropriate surgical care rather than nutritional support. Whereas nutritional support is required in these high-risk patients, anergy should not be the sole indicator for giving nutritional support or delaying an operation.
Two patients with gastrointestinal (GI) tract bleeding underwent preoperative selective visceral arteriography that demonstrated small-bowel tumors compatible with leiomyoma. A review of the material ...indicates that 42% of patients with small-bowel leiomyomas also have GI tract bleeding. Arteriography is valuable in obtaining a preoperative diagnosis.
We wanted to determine the long-term effects of a continuous infusion of PGE1 on D˙O, and V˙O2 in patients with ARDS. Data were obtained from a randomized double-blind multicenter trial, which ...evaluated the effects of PGE1 on survival in patients with ARDS. Patients were stratified according to treatment and outcome: placebo-died (n = 8); PGE1-died (n = 12); placebo-survived (n = 9); and PGE1-survived (n = 8). In the placebo-died group, elevations occurred in V˙O2, which were associated with increases in O2ext and a constant D˙O2. In contrast, in the PGE1-died group, elevations in V˙O2 were associated with increases in D˙O2 and an unchanged O2ext. In the placebo-survived group, V˙O2 and D˙O2 decreased, whereas in the PGE1-survived group, V˙O2 and D˙O2 increased; however, O2ext decreased in both of these groups. Since impaired O2ext occurs in ARDS, PGE1-induced elevations in Do, rather than compensatory increases in O2ext, may achieve better tissue oxygenation. We conclude that although the recently completed multicenter trial failed to show an enhancing effect of PGE1 on survival in patients with advanced ARDS, PGE1 may have important effects on oxygen transport and, therefore, may still have a role in the treatment of early manifestations of ARDS, either alone or in combination with other agents.
