Basic Cardiopulmonary Resuscitation Research Articles

The basic and advanced cardiopulmonary resuscitation skills of trained hospital nursing staff.

The cardiopulmonary resuscitation skills of 105 trained hospital nurses were tested. Both basic and, for the first time in the UK, advanced skills were examined; basic skills were assessed by practical evaluation with a standard manikin and advanced knowledge by multiple choice questionnaire. No nurse adequately performed all four practical skills tested. Knowledge of the ventilatory aspects of resuscitation, defibrillation and advanced technique and drug management were also found to be poor. The findings add further support to adequate training of nurses in resuscitation skills. We describe a solution to overcome the heavy demands of such teaching and suggest that the same model be applied to the training of medical staff in resuscitation skills.

In-flight Deaths During Commercial Air Travel

Do passenger deaths occur during commercial air travel? If so, how often and from what causes? We reviewed information reported to the International Air Transport Association on in-flight deaths that occurred during commercial air travel for the eight years between 1977 and 1984. Of the 120 airlines in the International Air Transport Association, 42 carriers reported deaths during these eight years. A total of 577 in-flight deaths were recorded, for a reported average of 72 deaths per year. Deaths occurred at average rates of 0.31 per million passengers, 125 per billion passenger-kilometers, and 25.1 per million departures. The majority of those who died were men (66%, 382/577) and middle-aged (mean age, 53.8 years). Most of the individuals (77%, 399/515) reported no health problems prior to travel. Physicians aboard the aircraft offered medical assistance for 43% (247/577) of the deaths. More than half of the deaths (56%, 326/577) seemed to be related to cardiac problems. Sudden unexpected cardiac death was the cause of death in 63% (253/399) of the apparently healthy people and seems to be the major cause of death during air travel. These observations support the initiation of programs to train cabin personnel in the skills of basic cardiopulmonary resuscitation and in the use of automatic external defibrillators.

Outcome of cardiopulmonary resuscitation in children.

A study was undertaken in order to identify factors correlated with the outcome of pediatric cardiopulmonary resuscitation (CPR). A total of 35 children who experienced a total of 41 cardiopulmonary arrests were included. Sixteen of 41 patients (39%) could not be resuscitated; 16/41 (39%) were resuscitated temporarily but did not survive to discharge; 9/41 (22%) survived to discharge. Patients arresting outside the hospital who received early basic CPR at the scene were significantly more likely to be resuscitated, at least temporarily, than those who did not (8/8 vs 5/11; P = 0.02). A statistically significant difference in outcome was also demonstrated between patients with an initial arterial blood pH greater than 7.0 and those with an initial arterial blood pH less than 7.0 (P less than 0.05). We conclude that an initial arterial blood pH less than 7.0 predicts a poor outcome from cardiopulmonary arrest in children. Access to early basic CPR may improve the initial pH and the ability of the patient to be resuscitated.

Teaching of cardiopulmonary resuscitation by medical students

Ten first-year medical students were taught basic cardiopulmonary resuscitation (CPR) according to the guidelines laid down by the American Heart Association. Following a 7.5-hour instruction period they, in turn, taught 40 secondary school pupils. On formal assessment using models, all the school children were able to perform basic CPR.

Pulmonary aspiration during unsuccessful cardiopulmonary resuscitation.

The incidence of pulmonary aspiration in a group of patients who did not respond to cardiopulmonary resuscitation (CPR) was assessed at autopsy and found to be 29%. This figure is undoubtedly an underestimate of the total problem, and some indication of the potential for aspiration during CPR is revealed by the fact that 46% of the patients studied had full stomaches at autopsy. Clearly this fact has implications for CPR methods as suggested by Cummings and Eisenberg. The problem could be reduced by incorporating the use of cricoid pressure into the techniques of Basic CPR but this will require modification of current teaching.

Pediatric resuscitation without an intravenous line

The case of a 3-month-old male infant who was found unresponsive and cyanotic in a crib at home is presented. On arrival in the emergency department the child was receiving basic cardiopulmonary resuscitation (CPR) by a rescue squad and was without vital signs in asystole. The patient achieved a stable rhythm and blood pressure before intravenous access was obtained. Epinephrine and atropine were given via the endotracheal route and sodium bicarbonate through intraosseous infusion.

Prehospital Cardiopulmonary Resuscitation

To the Editor.— recent article on prehospital cardiopulmonary resuscitation (CPR) 1 is excellent within its scope, but it is imperative to emphasize a key phrase: The clinical data suggest that bystander CPR buys valuable time, until definitive procedures (such as defibrillation) can be applied. Basic CPR, in itself, will rarely save a life unless more advanced intervention is available. To this end, the teaching of advanced cardiac life support (ACLS) has been gaining acceptance in this country. A major impetus behind the increased support for the teaching of ACLS has been the expanded awareness that approximately 330,000 people who die each year of coronary heart disease do so in the first symptom hour. 2,3 Many of these arrests may be reversible. 4 Advanced cardiac life-support training encompasses a wide spectrum of advanced techniques including defibrillation, synchronized cardioversion, central line venipuncture, monitoring and recognition of dysrhythmia, adjuncts for artificial circulation, airway ventilation,

Prehospital Cardiopulmonary Resuscitation

TWO PARADOXES lie behind the question posed in the title of this article. First, rapid and widespread dissemination of the technique of cardiopulmonary resuscitation (CPR) occured before the underlying physiology was fully understood. Second, data that indicate discouragingly low coronary and carotid artery flow rates contrast sharply with the obvious lifesaving capacity of basic CPR. <h3>CPR</h3> In the early 1960s, Kouwenhoven et al¹demonstrated the effectiveness of closed-chest compressions for cardiac arrest; rapid worldwide dissemination of the technique soon followed. By 1974, the endorsement of influential groups such as the American Heart Association secured broad acceptance for standard CPR.²Kouwenhoven and co-workers thought that during CPR blood was expelled by compression of the heart between the sternum and vertebral bodies. Later, however, various research laboratories conducted what were, in effect, post hoc investigations into the physiology of CPR; by the 1980s, few researchers subscribed to Kouwenhoven and co-workers'

Oral surgery management of the geriatric patient.

SUMMARYBecause the management of geriatric patients is accomplished with increased risk for morbidity and mortality compared to average patients, dentists who treat the medically compromised geriatric patient should be ready for any emergency. It is the dentisfs responsibility to know basic cardiopulmonary resuscitation, to have trained his ancillary personnel in emergency techniques, and to have the proper resuscitative equipment available.As the geriatric population increases, so will the demands on the dental profession to provide care for the patients in this category. Geriatric patients require more time, patience, attention to detail, and evaluation before treatment is begun. Clearly, these increasing requests for treatment must be met and the patients delivered the best care the dental profession can offer regardless of compromising medical status.

Interposed abdominal compression-CPR in human subjects

Standard cardiopulmonary resuscitation (CPR) has been thought to produce approximately 30% of the usual resting cardiac output. Further increase of blood flow to vital organs may increase chances of resuscitation and decrease likelihood of permanent, residual central nervous system or cardiac damage. Various methods have been promoted, most requiring equipment not available to bystanders and time to initiate once advanced cardiac life support (ACLS) providers have necessary equipment at hand. Interposed abdominal compression-CPR (IAC-CPR), application of manual abdominal pressure during the release phase of chest compression in otherwise standard CPR, has been demonstrated in dogs to increase diastolic blood pressure by 100% and cardiac output by 75%. We measured systolic and mean arterial pressure (MAP) in a group of six cardiac arrest patients after resuscitation was deemed unsuccessful by the physician directing CPR. We alternated periods of CPR versus IAC-CPR measuring femoral and radial or brachial pressures in six subjects, and found a 50% increase in MAP (from 26 to 39 mm Hg). Central venous pressures (CVP) were measured in one subject and, using MAP minus mean CVP to determine mean perfusion pressure, we found a 37% increase (from 19 mm Hg to 26 mm Hg). We propose that IAC-CPR may be a significant improvement in basic CPR if these studies are reproducible in resuscitable patients.

Gastric rupture: An unusual complication of the esophageal obturator airway

The esophageal obturator airway (EOA) has been used in the Jerusalem area by the ambulance services approximately 1,000 times in the past six years. We report an unusual complication of the EOA in the case of a 50-year-old man rescued from drowning who received both basic and advanced cardiopulmonary resuscitation. He was ventilated by an EOA attached to an Ambu bag; however, resuscitation attempts were unsuccessful. Autopsy revealed gastric rupture.

Training in cardiopulmonary resuscitation for hospital attending physicians

The Joint Commission on Accreditation of Hospitals now recommends that all medical staff members participate in basic cardiopulmonary resuscitation (CPR) training and be so qualified. At the University of Nebraska Medical Center, a program was established utilizing a modification of the American Heart Association (AHA) basic cardiac life support training course. Only 30 of 144 full-time attending physicians (21%) had been trained in CPR according to AHA standards prior to inception of the program. Eleven of 12 attendings "trained in CPR" previously but not according to AHA standards were unable to pass the written or practical examinations and required additional formal training. During a 12-month period, 144 full-time attending physicians were trained with an average investment of four hours per physician. Economic cost to the institution in faculty time was estimated at $12,000.

Action Plan for Near Drownings.

In brief: The outcome of a near drowning depends on the patient's physical condition before the accident, the duration of submersion, the temperature of the water, and how much water entered the lungs and stomach. Dr. Podolsky describes the pathophysiology of drowning, a practical action plan for treating victims, and preventive measures. The key to successful management is shortening the duration and extent of hypoxemia. In addition, patients should be monitored in intensive care units for at least 24 hours, because potentially fatal complications may develop. Preventive measures include restricting access to unguarded pools and teaching the public basic cardiopulmonary resuscitation techniques.

Modular Approach to CPR Training

Basic and advanced cardiopulmonary resuscitation training is worthwhile yet time consuming. Anesthesiologists should be among the most qualified leaders in CPR teaching programs. Using a modular self-teaching presentation for basic and advanced cardiac life support courses, minimal instructor time is required to accomplish proficiency in both didactic and mannequin performance for participants. This method can be adapted to various educational levels and time constraints without compromising quality of teaching.

Evaluation of physician skills in cardiopulmonary resuscitation.

Thirty-five physicians at various levels of postgraduate training in internal medicine were evaluated for performance skills in cardiopulmonary resuscitation (CPR) according to standards of the American Heart Association. They were given instruction in only the cognitive knowledge related to CPR through lectures and a demonstration of the technique, without supervised manikin practice. Only 22% (8) of the physicians tested were able to adequately compress and ventilate the manikin in a simulated cardiac arrest. Although physicians are proficient in the use of drugs during resuscitative efforts, it is also imperative that they be able to perform basic CPR.

Basic Cardiopulmonary Resuscitation

Basic Cardiopulmonary Resuscitation

Cardiopulmonary resuscitation training in american dental schools and requirement for state licensure

A questionnaire was sent to every American dental school and each state and regional testing agency, requesting information on the teaching of basic cardiopulmonary resuscitation (BCPR) and its inclusion in the requirements for state dental licensure. The data indicates that 81 percent of the schools teach a course in BCPR and the remaining 19 percent may do so in the future. Presently, 5 states require certification in BCPR for licensure and 17 states indicated they will require BCPR certification shortly.

Airway obstructed by foreign material: The Heimlich maneuver

To investigate the application of a cough-creating thrust for the removal of airway-obstructing foreign material, the thrust was applied to six adult male anesthetized volunteers at the waist, at the low chest level, and at the midchest level, with the subjects in both the horizontal-lateral and the sitting positions. Air volume, peak air flow rate, and airway measurements were made. Both the low chest and midchest thrusts produced significantly better results than did the abdominal thrust. There were no side effects attributable to the thrusts. The ease of application and consistently better level of results indicate that the chest thrust is the technique of choice. The application of the chest thrust should be integrated into the concepts of basic life-support and cardiopulmonary resuscitation.