Cardiopulmonary resuscitation. A current perspective

Cardiopulmonary cerebral resuscitation

Cardiopulmonary arrest (CPA) is defined as the abrupt and unexpected cessation of spontaneous and effective ventilation and circulation. CPA can be the natural ending of a normal and long life; however, when CPA is the result of a reversible problem in an animal that has a treatable medical condition, rapid recognition and treatment may make the difference between a happy ending and premature death. Cardiopulmonary resuscitation provides artificial ventilation and circulation until advanced cardiac life support can be provided and spontaneous cardiopulmonary function is restored. The term cardiopulmonary cerebral resuscitation originated in the early 1960s in recognition of the severe central nervous system complications of prolonged cardiac arrest in human beings. Although neurologic complications of CPA may not be as noticeable in companion animals, newer brain-sparing strategies that recognize the consequences of reperfusion injury and the inflammatory cascade may some day offer improved survival.

Sodium bicarbonate in cardiac arrest: a reappraisal

The routine use of sodium bicarbonate in patients with cardiac arrest has been discouraged, with the benefit of outcome evaluation. Current recommendations include an elaborate stratification of circumstances in which bicarbonate is to be used. The physiological and clinical aspects of bicarbonate administration during cardiopulmonary resuscitation in animal and human studies were reviewed. The onset of significant acidemia or alkalemia is associated with adverse system specific effects. The administration of bicarbonate may mitigate the adverse physiological effects of acidemia, improve response to exogenously administered vasopressor agents, or simply increase venous return due to an osmolar effect, resulting in increased coronary perfusion pressure. Likewise, bicarbonate may have adverse effects in each of these areas. The preponderance of evidence suggests that bicarbonate is not detrimental and may be helpful to outcome from cardiac arrest. An objective reappraisal of the empirical use of bicarbonate or other buffer agents in the appropriate "therapeutic window" for cardiac patients may be warranted.

External transcutaneous pacemakers in interhospital transport of cardiac patients

From October 1985 to April 1988, 297 patients with presumed unstable angina, acute myocardial infarction, or permanent pacemaker failure were transferred by helicopter from community hospitals to our medical center for tertiary care. Fifty-six patients (19%) experienced treatable bradycardia (heart rate of less than 50) and hypotension (systolic pressure of less than 80 mm Hg); nine patients (16%) improved without treatment, 24 (43%) responded to atropine, and 23 (41%) were unresponsive to atropine. An external transcutaneous pacemaker (EXTP) was applied to patients unresponsive to atropine if a transvenous pacemaker could not be placed. In the atropine-unresponsive group, 11 (48%) had a transvenous pacemaker placed successfully, two (9%) had poor transvenous pacemaker capture (followed by EXTP capture), and ten (43%) were treated with EXTP alone. Eleven patients experienced EXTP capture and improved. Six had profound bradycardia and apnea before EXTP application. Of the 297 patients, 23 (8%) required transvenous or external pacing, and 12 of these patients (52%) survived. The availability of external pacing during interhospital transport of high-risk cardiac patients seems necessary for the management of symptomatic bradycardia and hypotension.