Transcript cpr at dewan mushtaquex

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DR MASHOOQUE ALI DASTI
MD CARDIOLOGY
Introduction
At least 350 000 people will suffer cardiac arrest each year in the
United States, 1 every 90 seconds.
Many will then undergo cardiopulmonary resuscitation (CPR) by
bystanders and emergency medical services in a desperate
attempt to restore life.
Numerous studies report that the majority of these efforts will not
succeed.
Prolonged anoxia, the inability to restore spontaneous circulation,
neurological devastation, and other complications combine to
limit survival.
It is a young science; the term "CPR" was first publicized less than
50 years ago
Highlights of the History of Cardiopulmonary Resuscitation (CPR)
1740
1767
1891
1903
1904
The Paris Academy of Sciences officially recommended mouth-to-mouth
resuscitation for drowning victims.
The Society for the Recovery of Drowned Persons became the first organized
effort to deal with sudden and unexpected death.
Dr. Friedrich Maass performed the first equivocally documented chest
compression in humans.
Dr. George Crile reported the first successful use of external chest
compressions in human resuscitation.
The first American case of closed-chest cardiac massage was performed by Dr.
George Crile.
1954
1956
1957
1960
James Elam was the first to prove that expired air was sufficient to
maintain adequate oxygenation.
Peter Safar and James Elam invented mouth-to-mouth resuscitation.
The United States military adopted the mouth-to-mouth resuscitation
method to revive unresponsive victims.
Cardiopulmonary resuscitation (CPR) was developed. The American Heart
Association started a program to acquaint physicians with close-chest
cardiac resuscitation and became the forerunner of CPR training for the
general public.
1963
1966
1972
1981
Cardiologist Leonard Scherlis started the American Heart Association's CPR
Committee, and the same year, the American Heart Association formally endorsed
CPR.
The National Research Council of the National Academy of Sciences convened an ad
hoc conference on cardiopulmonary resuscitation. The conference was the direct
result of requests from the American National Red Cross and other agencies to
establish standardized training and performance standards for CPR.
Leonard Cobb held the world's first mass citizen training in CPR in Seattle,
Washington called Medic 2. He helped train over 100,000 people the first two years of
the programs.
A program to provide telephone instructions in CPR began in King County,
Washington. The program used emergency dispatchers to give instant directions
while the fire department and EMT personnel were en route to the
scene. Dispatcher-assisted CPR is now standard care for dispatcher centers
throughout the United States.
• . Dr Claude Beck and his first cardiac
defibrillator. Images courtesy of Dr Igor Efimov
(left) and the Dittrick Medical History Center,
Case Western Reserve University (right).
Statistics of Survival
Modern published studies of resuscitation for cardiac arrest (all
cardiac rhythms) show rates of survival to hospital discharge
that range from 1% to 25% for outpatients and 0% to 29% for
inpatients.
Of the first 20 patients who underwent closed-chest cardiac
massage, only 3 had ventricular fibrillation, and yet 14 survived
the arrest (70% survival).
In 1953, a review of 1200 in-hospital cardiac arrests reported
that, despite only 11% having ventricular fibrillation, 28% were
resuscitated to "permanent survival.“
OUTCOME OF CADIOPULMONARY RESUSCITATION
AFTER MYOCARDIAL INFARCTION
AT DEWAN MUSHTAQUE
• AIMS OF STUDY
• The purpose of this study was to evaluate in
hospital survival of the patients with
myocardial infarction who developed cardiac
arrest and to look into the factors associated
with success rate of CPR.
BACKGROUND
The major determinants of survival
after in-Hospital cardiac arrest depend
upon
1. The time factors,
2. How quickly it is initiated,
3. Extent of resuscitation efforts,
4. Expertness of team
5. Dedication of CPR team.
METHOD
• Prospective study of 126 patients admitted in DEWAN
MUSHTAQUE coronary care unit who received advance
cardiac life support protocol after in hospital cardiac
arrest during the period of six months.
• Short term survival (Return of spontaneous respiration
and circulation) and hospital survival at the time of
discharge were measured.
• In addition, factors affecting the outcome of CPR age,
gender, and duration of CPR, associated arrhythmias,
defibrillation and TPM implantation were also taken in
account.
•
RESULTS
• Over all 45 out of 126 patients (33%) who received
advance cardiopulmonary life support, survived to
hospital discharge.
• Survival was better in male i.e. 37% versus 26% in
female.
• young age group showed better survival 40% in age
range of 30 to 49 years, 33% in 50 to 69 years and 28%
in 70years and older.
• Survival rate was 86% when CPR duration was less than
10 minutes, at the 15 minutes 48% and at 20 minutes
CPR time, 25% patients survived. Only 13% patients
survived at CPR time of 30 minutes.
RESULTS
Survival was 42% for patients with VF and 68% in those
presenting VT, 61% in fast AF with heamodynamically
instability.
29% patients having TPM implantation survived of cardiac
arrest.
Poor survival in patients of cardiac arrest presenting with
new development of LBBB i.e. 18% , best in inferior wall
STEMI ( 32%) , intermediate in anterior wall STEMI ( 28%).
Total of 30 patients in cardiogenic shock had cardiac arrest
and 17% resuscitated successfully
CONCLUSION
Survival was highest for patients with primary
cardiac arrest, with short CPR duration, young
age, male with tachyarrhythmia.
Patients who experienced cardiac arrest at
cardiac emergency room have better survival.
Survival was poor in patients with cardiogenic
shocks, CPR duration more than 20 minutes