Cardiopulmonary resuscitation : Guideline recommendations meet clinical practice
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AbstractSudden cardiac arrest strikes individuals of all ages of both genders all over the world. Although mortality after out-of-hospital cardiac arrest is high, interventions performed by bystanders and health care professionals may bring cardiac arrested victims back to life and normal living. Guidelines for cardiopulmonary resuscitation (CPR) are largely based on experimental findings and include mouth-to-mouth ventilation, chest compressions, defibrillation of ventricular fibrillation and the administration of adrenaline. Our group recently showed that the quality of clinical CPR was poor with too shallow chest compressions and long intervals without compressions, differing from the optimal CPR quality that is typically performed in experimental studies.
The thesis demonstrates that the haemodynamic effects of adrenaline administered during CPR depend on the quality of chest compressions delivered. When CPR is performed similar to clinical findings, there are no haemodynamic effects of adrenaline in porcine cardiac arrest. Haemodynamic effects of adrenaline are only observed when optimal CPR is performed. In the same animal model, there are no beneficial haemodynamic or short-term survival effects of pre-arrest anticoagulation. The quality of chest compressions may be improved when trained ambulance personnel perform CPR with the defibrillator in manual mode compared to semi-automatic mode when following the 2000 guidelines for cardiopulmonary resuscitation. Finally, mouth-to-mouth ventilation during CPR produces hypercarbia and hypoxia when delivered to cardiac arrested patients by trained ambulance personnel. Our findings indicate that differences in CPR quality rather than differences in anticoagulation may be one reason why clinical studies on CPR have failed to confirm beneficial experimental findings.
List of papers
Paper I: Haemodynamic effects of adrenaline (epinephrine) depend on chest compression quality during cardiopulmonary resuscitation in pigs. Pytte M, Kramer-Johansen J, Eilevstjønn J, Eriksen M, Strømme TA, Godang K, Wik L, Steen PA, Sunde K. Resuscitation. 2006 Dec;71(3):369-78. Epub 2006 Oct 4. doi:10.1016/j.resuscitation.2006.05.003
Paper II: Pre-arrest administration of low-molecular weight heparin in porcine cardiac arrest - hemodynamic effects and resuscitability. Pytte M, Bendz B, Kramer-Johansen J, Eriksen M, Strømme TA, Eilevstjønn J, Brosstad F, Sunde K. Critical Care Medicine. 2008 Mar;36(3):881-886. DOI: 10.1097/CCM.0B013E318164E781
Paper III: Comparison of hands-off time during CPR with manual and semi-automatic defibrillation in a manikin model. Pytte M, Pedersen TE, Ottem J, Rokvam AS, Sunde K. Resuscitation. 2007 Apr;73(1):131-6. Epub 2007 Jan 30. doi:10.1016/j.resuscitation.2006.08.025
Paper IV: Arterial blood gases during basic life support of human cardiac arrest victims. Pytte M, Dorph E, Sunde K, Kramer-Johansen J, Wik L, Steen PA. Resuscitation 2008 Apr; 77(1):35-8. Epub 2007 Nov 26. doi:10.1016/j.resuscitation.2007.10.005