Heart-Alert: emergency resuscitation training in the community

One approach to reducing avoidable mortality from coronary artery disease is to provide resuscitation capability in the community. In Manitoba this is the function of the Heart-Alert program, sponsored by the Manitoba Heart Foundation. The program is based on public and professional education dealing with the recognition and immediate care of cardiac emergencies, including cardiopulmonary resuscitation (CPR). The three components to the program are (a) training in basic CPR for all health care and community rescue groups; (b) training in definitive CPR for physicians, critical care nurses and advanced emergency medical technicians; and (c) education of the public to recognize the signs of impending or actual cardiac emergencies and to take appropriate action to summon quickly an emergency rescue team.The initial emphasis of the program has been on developing an organizational structure and a training network for basic CPR. A corps of instructor-trainers and instructors has been certified to implement CPR training in the medical and community target groups. Developmental problems include problems of quality control, of providing for self-sustaining and continued expansion, and of evaluation of the overall results.It is suggested that widespread implementation of CPR training is facilitated by the incorporation of CPR into existing training activities, particularly those of the medical, nursing and other health care disciplines, those of community protection agencies such as police, fire and ambulance departments, and those of volunteer groups concerned with rescue work and first-aid. If the impetus, organizational structure and instructor training are provided by a strategic agency, wide dissemination of CPR training is then possible at relatively modest cost.     

Physicians' and nurses' retention of knowledge and skill after training in cardiopulmonary resuscitation.

Physicians and nurses in a community hospital who successfully completed the standard 1-day training program in basic life support cardiopulmonary resuscitation (CPR) were retested 6 and 12 months after training. Their perceptions of their knowledge of and skill in CPR were recorded along with an account of the roles they had taken in CPR incidents. The physicians and nurses initially had the same level of knowledge of CPR, but the physicians learned significantly more and retained it longer. After training, the nurses participated much more in CPR incidents, limiting themselves to basic life support functions. The physicians'' participation, however, remained at about the same level and was limited to advanced life support functions. By 12 months after training the scores in both groups were similar to the pretraining scores, which suggests that practice with feedback is necessary during the 1-year period before retraining and recertification. It may be that the two groups require different training programs.     

生理驱动高仿真模拟技术在心肺复苏培训中的应用

目的:探讨生理驱动高仿真模拟技术对于提高医护人员心肺复苏能力的效果及必要性.方法:对126名新入院医护人员进行基本急救知识摸底测试,然后使用简单急救技能操作模拟器和生理驱动高仿真模拟人,应用"简短理论讲授+分项技术练习+综合模拟演练+录像回放分析"方法进行急救技能培训,分析培训效果,总结反馈意见.结果:培训前心肺复苏理论成绩45.81±5.23,心肺复苏操作技能及格率仅为11.36%.经短期培训后,再次以同等难度试卷测试,平均理论成绩为92.85±6.25,心肺复苏操作测试合格率为100.0%,与培训前平均成绩比较有显著的提高(P<0.01);对接受培训者的反馈意见进行分析,认为有必要加强急救培训者占95.2%;认为高仿真模拟急救培训对今后医疗工作中处理紧急突发事件或急危重病人有重要帮助者占98.4%.结论:生理驱动高仿真模拟培训对提高急救意识和实际应急能力有重要帮助作用,有必要对医护人员定期进行急救知识和技能培训.     

Appraisal of pediatric cardiopulmonary resuscitation.

Sixty-six patients more than 30 days and less thant 16 years of age suffering an unexpected cardiac arrest in an 18-month period were included in a study of resuscitative measures in children. Six children survived to be discharged from hospital. Respiratory disease accounted for most (29%) of the cardiac arrests, but it also had the most favourable prognosis, 21% of the 19 patients surviving. None of the patients survived whose cardiac arrest was secondary to sepsis or trauma, even when the resuscitative efforts were initially successful. Only 1 of the 41 patients who had a cardiac arrest outside of hospital survived, and only 1 of the 34 patients who presented with asystole survived, and then with considerable damage to the central nervous system. The interval between cardiac arrest and application of basic life support was substantially shorter among the survivors. Also, most of the survivors did not present with asystole. The results of this study suggest that survival among resuscitated children is no better than that among adults but can be improved with early recognition and monitoring of children at risk. earlier application of basic and advanced life support, improved education of medical and lay personnel, and further research into pediatric resuscitative techniques.     

Withholding cardiopulmonary resuscitation: proposals for formal guidelines.

Working with members of the Royal London Trust and its medical council, Len Doyal and Daniel Wilsher have composed a set of guidelines governing the making of decisions to withhold resuscitation from patients. The guidelines describe the procedures that should be followed when giving orders for non-resuscitation and the clinical, legal, and moral criteria that should be satisfied before such orders are issued. The authors hope that these guidelines will be of help to those responsible for the creation of hospitals'' policies for non-resuscitation.     

Acute posthypoxic myoclonus after cardiopulmonary resuscitation

ABSTRACT: BACKGROUND: Acute posthypoxic myoclonus (PHM) can occur in patients admitted after cardiopulmonary resuscitation (CPR) and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of the study was to investigate whether acute PHM originates from cortical or subcortical structures, using somatosensory evoked potential (SEP) and electroencephalogram (EEG). METHODS: Patients with acute PHM (focal myoclonus or status myoclonus) within 72 hours after CPR were retrospectively selected from a multicenter cohort study. All patients were treated with hypothermia. Criteria for cortical origin of the myoclonus were: giant SEP potentials; or epileptic activity, status epilepticus, or generalized periodic discharges on the EEG (no back-averaging was used). Good outcome was defined as good recovery or moderate disability after 6 months. RESULTS: Acute PHM was reported in 79/391 patients (20%). SEPs were available in 51/79 patients and in 27 of them (53%) N20 potentials were present. Giant potentials were seen in 3 patients. EEGs were available in 36/79 patients with 23/36 (64%) patients fulfilling criteria for a cortical origin. Nine patients (12%) had a good outcome. A broad variety of drugs was used for treatment. CONCLUSIONS: The results of this study show that acute PHM originates from subcortical, as well as cortical structures. Outcome of patients admitted after CPR who develop acute PHM in this cohort was better than previously reported in literature. The broad variety of drugs used for treatment shows the existing uncertainty about optimal treatment.     

The oesophageal obturator airway: a new device in emergency cardiopulmonary resuscitation.

Experience with 29 000 cases in which the oesophageal obturator airway has been used in cardiopulmonary resuscitation indicates its safety, efficacy, and ease of use. Blood gases, fractional inspired oxygen, and pH were measured in 18 patients given both the oesophageal obturator airway and the endotracheal tube; there was no significant difference between the two. The former was found to be inserted more rapidly and reliably; moreover, paramedical staff are quickly trained to use it. It is concluded that the oesophageal obturator airway provides the technique of choice whenever ideal conditions and facilities--and trained staff--for endotracheal intubation are not immediately available.     

Successful bystander cardiopulmonary resuscitation complicated by liver rupture

A 40-year-old man, who had collapsed while running and was resuscitated successfully by bystanders, was referred. An automated external defibrillator had shown ventricular fibrillation before a single shock restored sinus rhythm. On arrival, the patient was alert and haemo-dynamically stable. He reported that he had recently suffered from chest pain during exercise but had not visited his general practitioner; before collapsing he had no complaints. Physical examination showed a moderately tender abdomen with normal peristalsis.