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.     

A community training scheme in cardiopulmonary resuscitation.

Community instruction in basic life support and resuscitation techniques has been offered in Brighton Health District since 1978. Classes are held frequently for the general public and businesses, schools, and other organisations. First aid care for unconscious patients, the treatment of respiratory obstruction or failure, and the recognition and management of cardiac arrest is taught in a single two hour session. Over 20 000 people have been taught, up to 40 at a time in multiple groups of six to eight, by lay instructors usually supervised by ambulancemen trained to "paramedic" standards. Fifty four incidents have been reported to us in which techniques learnt in the classes have been implemented. Five patients recovered after first aid support but subsequently did not seek medical treatment. Of the 34 patients reviewed in hospital, at least 20 survived to be discharged. We believe that intervention may have been life saving in 16 instances. The benefit of cardiopulmonary resuscitation for victims who may have been asystolic is, however, difficult to quantify because the outcome without intervention cannot be predicted accurately. Community training in basic life support should be considered in association with ambulances equipped for resuscitation and hospital intensive care and cardiac care units as an integrated service for the victims of sudden circulatory or respiratory emergencies. The results achieved so far in Brighton and in other more advanced schemes, particularly in the United States of America, may encourage other health authorities to adopt similar programmes.     

A new airway device for small laboratory animals

There is a need for a device for improved management of the airway of small laboratory animals during general anaesthesia. This report introduces such a device, referred to here as the airway device (AD). The AD has some similarity to the laryngeal mask airway (LMA) developed for human patients, but the mask portion of the device is specifically designed for small laboratory animals. In addition, the device has an oesophageal extension and unlike the LMA does not have a cuff associated with the mask. This report also shares experience of tests of one prototype AD with six New Zealand white rabbits. The AD was used for administering isoflurane and its effectiveness was evaluated during conditions of spontaneous and controlled intermittent positive pressure ventilation. The results provide encouragement for further development of the AD for airway management of small laboratory animals.     

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.