RT Book, Section
A1 Otto, Charles W.
A2 Longnecker, David E.
A2 Mackey, Sean C.
A2 Newman, Mark F.
A2 Sandberg, Warren S.
A2 Zapol, Warren M.
SR Print(0)
ID 1144135783
T1 Cardiopulmonary Resuscitation
T2 Anesthesiology, 3e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071848817
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1144135783
RD 2024/04/18
AB KEY  POINTSDuring  many  in-  and  out-of-hospital  resuscitation  attempts,  less  than  half  the  time  is  devoted  to  chest  compressions.  Interrupting  compressions  reduces  myocardial  perfusion  and  is  detrimental  to  the  ultimate  success  of  resuscitation.  Maintaining  uninterrupted  chest  compressions  must  be  the  first  priority  during  cardiopulmonary  resuscitation.The  relative  importance  of  chest  compressions,  ventilation,  and  defibrillation  during  resuscitation  must  be  adjusted  for  the  context  of  the  rescue  situation  and  the  personnel  available.When  an  arrest  is  witnessed,  which  is  likely  to  be  of  cardiac  (rather  than  respiratory)  cause,  and  advanced  care  will  be  available  within  a  short  time,  closed  chest  compressions  alone  may  be  as  efficacious  as  compressions  and  mouth-to-mouth  ventilation.Interrupting  chest  compressions  is  harmful,  occurs  frequently  and  reduces  survival.Fluctuations  in  intrathoracic  pressure  play  a  significant  role  in  blood  flow  during  most  resuscitations,  and  the  cardiac  pump  mechanism  contributes  under  some  circumstances.The  critical  myocardial  blood  flow  is  associated  with  aortic  diastolic  pressure  exceeding  40  mmHg.Cardiac  output  is  severely  depressed  during  cardiopulmonary  resuscitation  (CPR),  ranging  from  10%  to  33%  of  prearrest  values  in  experimental  animals.  Nearly  all  of  the  cardiac  output  is  directed  to  organs  above  the  diaphragm.During  CPR,  measurement  of  blood  gases  reveals  an  arterial  respiratory  alkalosis  and  a  venous  respiratory  acidosis  because  the  arterial  Pco2  is  reduced  and  the  venous  Pco2  is  elevated.Exhaled  end-tidal  CO2  is  an  excellent  noninvasive  guide  to  the  effectiveness  of  standard  CPR.Defibrillation  for  VF  arrest  is  most  effective  if  applied  within  4-5  minutes  of  collapse.  Otherwise,  a  brief  period  of  2-3  minutes  of  chest  compressions  before  defibrillation  may  improve  survival.Amiodarone  and  lidocaine  are  used  during  cardiac  arrest  to  aid  defibrillation  when  ventricular  fibrillation  is  refractory  to  electrical  countershock  therapy  or  when  fibrillation  recurs  following  successful  conversion.It  has  been  questioned  whether  any  drug  therapy  improves  outcome  from  cardiac  arrest.  In  recent  drug  trials,  if  any  effect  was  found,  it  was  only  short-term  outcomes  of  improved  return  of  spontaneous  circulation  or  admission  to  hospital.Outcome  studies  prospectively  comparing  standard  and  high-dose  epinephrine  have  not  demonstrated  conclusively  that  higher  doses  will  improve  survival.Evidence  currently  suggests  that,  like  other  potent  vasopressors,  vasopressin  is  equivalent  to  but  not  better  than  epinephrine  for  use  during  CPR.All  resuscitated  patients  with  ST  elevation  as  well  as  those  without  ST  elevation  when  an  acute  coronary  event  is  suspected  should  undergo  emergent  coronary  angiography  regardless  of  their  neurological  status.In  contrast  to  pharmacologic  therapy,  three  randomized  controlled  trials  (RCTs)  demonstrate  improved  neurologic  outcomes  when  targeted  temperature  management  (maintaining  a  constant  temperature  between  32-36°C)  is  induced  for  12-24  hours  in  cardiac  arrest  survivors  who  remained  comatose  after  hospital  admission.