Clinical Science Abstracts From the RHuscllalion Science Symposium 2006 11-1209
compared with adult ('.j(ms, Methods FolklWing 7 minutes of untreated \IF, 24 piglets were randamued to receive eltller bll'W)aSic Shocks at 35-35-35 J (8135 �ocp) or 50-75-SS J (8i50 group) \'la pedla!Jk;-slf.ed pads t'K adult SOOCks at 200-300-360 J (81200 group) via 8dUtt ,adS. __ per_l!LS_ ID20 m.1...., 11"'1-ALS prolOGtJl 10 27 minutes.. A fll.lltpauunetric st:attstl;:al toot �-Wallis wl!h Doon comid!OO) was used. - Piglels !19±31<Q) reqood more Bl35 1llall 8'2llll - ID - tt1e lnillal VF eplsoda \p=0.03) and mceived more� overall (7.9±ft3 vs 1.4.±0.5, p=0.008f, There was no signmcanl: � ootween th& 3 � kl cumutative dose. ArlimalG deflbriHated w!lh 35 J had a 10% decl'tlase in LVEF fiMt basetlne at 4 hoots 'le!3US a 32% decrease ln plgtets receMr'J tne M!Jlt dose shxk (P"'0.14). 61.mal to 4 hourn was nearly equal betw&erl ttle three !1001)8. wtth good neurcfogk:al ootcome fl 7/8 Bl35 piglets versus 3/8 Bf200 (p=0.09). Conclusion Outcomes were similar for tt»s lower dose and the previousty J)f(IYen 50 J pediatric AED dose. eomparoo to ttie adult dose, both attenuate<1: doses 1eflded t.o be associated with less myocardial dysfunction and better 24-llour outcome. Alttlough this lowest dose required more shocks than the adult t10se, our resutts suggest that this new, !owe(' 00$0 would be safe and effective for pediatric defibtillation.
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Resuscitation Science Symposium: The Best of the Best - (Abstract Oral Session II) Sal11rday Afternoon McCormick Place, S100c Abstracts 106-11 O
Increasing CPR during OU!-ol·hospltal Ventrlcular Rbrllla!lon /IITe$1: Sumvai lmpflcations of Guldelne Changes
fhomas D Rea, Univ of Washlngtoo, Seattle, WA:, Miehael Helbock, stephen Perry, Don Cloyd, King County Emergency Med Services Div, Seattle, WA; Mickey S Eisenberg; lJniY of Washington, Seattle, WA
Background: The most recent teSUScitation guidelines nave sought ta !mprova the Interface between rlelibrillatioo and CPR However, the SlJirival lll'llllcations or ltll:!:Se -0banges are t.'flknOWn. A year Pf« to issuance cl the most receRt guidelines, !he EMS of _the study community implemenbXI prof(leol changes that !,TOViderl a single .'tlOck WltOOUt rh}'thm reanaJysa, stacked.,_" post-<l-"'1lon,,.,.. cil-. ""1• """'1dir;J""' period ul cm from 1 to 2 mlnute:t W& � Sil'Ylval WOllld be better in lffllientS treated wffll the new jXOtocol. Matttoos-: The stt.id;' too1i_ place In a commooity wttn a fwo..tiered EMS � and ari established system of ca.niiac arrest UWll!ance, t.rair'ilg. and miew. Per the !Jlsteln template, the investli,atloll was a <:ooM study Of pernom Sl.lffemlQ �r ·Witnessed, oot-ot-tiospital wntricufarfbilfffl:lM amlSt due fu heart disease that arnpared a PfOSpecilvelycrefined intervention group (Januaiy 1, :2005·Janoary 31, 2006) wili1 a historical comrol !)(00!) mat was treated wl1n Ure prior r,uidel!oo � Of myttwn reaoat/SIS, stacked shocks, amt post-defibri!!ation pulse cl100kS (January 1, 2002-0ecember 31, 2004). k1 fal of 2004, EMTs were trained regarding ltle new prot.ooor and A£Ds were reprogrammed. The primary outurne was survival to hoepltal discharge. Logistic rei,ession was used t.o assess the assoclatiOll between survival and study period whlle accouotirJg for potential confounder$. ReNts: The proportion ol all treater:! arrests m&etlng lncius!M crtteria was similar for rrtervootkm ant1 cootro! periooo {15.4% 1� vemos 16.6% ir�). SUrvlval to hospital discharge was greater OOring the irrterverrtioo axnpared to C0!1'lrol period (46% eYi1-1 �rws 33% 1%_., p=0.008). Adjustment !or co- did not - the assoclmioo. Bel1llr - """"" during the int�l.m period correspom;loo to a graatei proporttoo with rettJTI of ck'tlJatloll at the end of EMS care (74% 9o/1J<i versus 00% �•l u Weil as a necrease IO too l!1terVal from in11!3i shock to start of CPR (7 � versus 28 serooos) based on electroolc AEO reoord review, Com.:luskin! 1hese results suggest the (ll!IW goiOOJ!rre approach will alt.et the imeTtace between deflbrt!!ation and CPR aoo !n tum may ll'llfX'O'le outcome.
107 comparison Between cenobral Mlcroclrculatory Blood Row Following Epinephrine and Vasopremn During CPR
Giuseppe Ristagno, Shijie Sun, Lei Huang, Yun�Te {l)Mg, Wanchun Tang, Max H �U; The We!! Institute of Crttlcai care. Rancho Mlrage, CA
!ntrooucuon. Both epineprn1na and va:sopmsln lliCtl?aSe cere:lxal oortlcal 18:rt,e YeS&el p1essure when administered Wring CPR, HoweYer. we recently� ttfflt � llldUres"""""' OOl1i<:al IJlicrocin:uial blood 1low tMB!J. -· we e,pklrnd tt1e effects of noo-adrenetglc � Ofl woorn.1 � perlusioo, Mlttlod$. Ten oomestlc mala pSgs weighing 40 ±: 2 kg were rn:ub8le(f n mechallicaffy � A tronto�I tliateral craniotooly was creatfflL MBF was. measured with the Orttlogooal Polarilatlon Spectral imaging melllO<! using"" CYTOSCNI NR � Inc., ,,,_,p111a, PAI- Th!8oo "1lloo diOxide- tension (Pr,C()zi was meaa.ired wltt! a miniattre carton � tls.lue electro
(C02-02-PH AllG Modul� Opl1cal Sensora loo, MN), BklOl! 11ow "'6cily in pial and peneOtlllng vessels < 2-0 wn was yraded trom o (oo flow) to 3 (normal;. VerllrtuJar fillillatioo (VF} was looiced t7t ill AC cummt dellvered to the tight \'8fJtrmar 6fldocaroi1Jll. VF was 1,mmted 10!' 3 min. AmnaJs were ranoomired 10 recen,e � � (30 µglkg} or� {0.4 U/YJ,j) at one minute 8.ftef the start ot CPR. Af!Bf 4 mirnrtEs ot cm irdlding JXl)OOfdial -and-wllh'"l1Jllll,-was-.-AD811imiis Wffil """"""'Y - 6lgolflcootty- P.CO, and - MBF- ,_ -""""""1! lfl@tre). -· C<i!1icaJ m""°"""""tlloOl!ffowWllll-""' -· butootan.,-.
3
MBF 2
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17
Use of an Impedance - -..1m_.. Survival in a Suburl>an EMS Systam
l..evoo vartaniari, Gregory Wolf, Allen Sims, Kevin Traynor; Cypress creek EMS,. Spring, TX
Introduction: Toe 2005 AHA guhfelJnes recentty recommended (Class All) tne ur.e of an impedance threshokl device (ITDJ to lntrea,e CircU!ation and reb.Jm of spomaneous cin::ulatlon (ROSC} rates in patients in can1iac: arrest Hypothesis: We assessed 1he hypothesis that adding an rro to staooard au, and ALS resuscilliliOO effOrts would � soorM&rm uvh1B1 In patients with out-m� eardlac arrest from au causes when CW!pared lo histoncal controls. Methods: Cypress Cret1k EMS (POpt.!latlon 4001{) covers a sutlurt.l:arl area North Of Houston (J'Xl In Harris County. f'«.im 8105-4/06, 104 patjerrts in cardiac arrest wtre prospecttvely treated with an ITD (ResOPOt>-.i and SUl'Yival results were oom!)fflld tu hiStorical coolrots (n=143) from 8Kl4-71D5 whim an !TO was not ln use, The primary.,, endpoint was ROSC. A Chi square test was used fof statistical �. Age, gern.lsr and EMS response time: (-B min) W$re eYenly matched between group$. The rm W3$ used oo all patieflts In cardiac arrest (all etkl!Oglesl wno were > 1 year ot age, It was applied -1 o minutes after HI& 911 can, 'lypitalty first oo a tacemask and then m<wed tn an enootracfleal ttlbi! fi the patient was. illrubated. Resulta: ROSC rates were 45% In the historical control groop vs. 59% In rro patients iP=0.03). Neurologlcatty intact ttospltal Cllseharge rates Improved from -10% [controQ to 17% In tile ITO group jp=ns>, The bemif!t was observecd regardless ot presenting rttythm, including 4 ITTMreated patients wltt1 intact neurntoglcar status at dtscnarge whO presented with asystole vs. none in tile control group. There were no adverse events associated with fTO use. Conelusion: In coociuslon. foUowlng ITD 'implementation, ROSC rates Increased by 29% and neurologically Intact discharge rates lmprovoo by >50%. Use ot the rro was easily and raprmy implemented, resuttlRY In a signltiearrt Improvement In sorvfval • ttie highest overall resuscitation raws oooerveo in the 30-year rnstory of the Cypr,ess Creek EMS systMl.
t,-, VBl!tila1!on Rates lmp!1)9& lltain Tissue llxygenalloo alld Perlusl01l During Hemorrhaglo Slloct
M.vned H ldiis, Samue{ ltll:ler, Joseph P Millei, Ctristqther Madden, RQnllle J Brown, Paul P Pepe; Univ of Texas Soothwestem Med cmr, Dallas, TX
Bac::kground: Recent sturtles showed that arterial blood pressure cfuring ttemorrMQie Shock is made worse with t,yperventllatron and Improved with a Yentilation rate o1 6 breaths/min. Oblectlve: To compare the effect of three vent!latlon strat"egl!8 on brain Us.sue P02 {PJ)2) and perfusion In an anlmal model of nemorrha!llc shock. Method!: Swine {mean weight 5it4 3.3 kQI were l'ao(l()mly allocated lo receive ooe of three ventl!atloo stratewes after hemorrhage: 12 1>reatl!s/m!11 {N= n. 6 breaths/m«'l (N""6i, or ventllatlon rate adjuated to mal!ltdn a target end�tidaI CO2 (ETCOJ = 40 mm Hg. Suffic:lent blood was removed to maintain a target IT!Ml'I arterial pressure {MAP) = 35 :t 5 mm Hg atmg a 40 min period. Thrne UOOX prolleS {lntegra Nflurosciences) and a tissue perfusion probe (tntegra Neurosclaocasj were placed In tne cetebfal cortex. aru:I output was reooroed cootioooosly. During the basefina period, vem:natron rate was 12/min tor all groupa. Tidal VOiume was adjusteo: to maintain ETOO., = 40 mm Hg dl.lffllg 1he basellne period and remaioeo unchanged thereartec ROi= 1 soo arterial hefflQ91obtfl oxygen $i!turaffoo was 100% for all animals at all times , lmmedmtety afler !Jemorrhage and actllew'lg the target
