Ongoing research suggests that the duration of ventricular fibrillation (VF) is a consideration in deciding whether to defibrillate immediately and as soon as a defibrillator is available or to perform cardiopulmonary resuscitation (CPR) for a brief period first to “prime the pump” before proceeding to defibrillation. In the porcine model in the setting of prolonged VF (> 10 minutes), CPR before countershock provides several physiologic benefits. Studies have found that patients with VF of longer than 5 minutes’ duration had better return of spontaneous circulation, survival to hospital discharge, and 1-year survival if ambulance personnel provided 3 minutes of CPR before performing defibrillation than if ambulance personnel performed defibrillation immediately after arriving at the scene; however, some experts question the validity of these results, on the basis of study design.

What’s New in ACP Medicine Cardiac Resuscitation

From ACP Medicine

Terry J. Mengert, MD Immediate Defibrillation or CPR? Ongoing research suggests that the duration of ventricular fibrillation (VF) is a consideration in deciding whether to defibrillate immediately and as soon as a defibrillator is available or to perform cardiopulmonary resuscitation (CPR) for a brief period first to “prime the pump” before proceeding to defibrillation. In the porcine model in the setting of prolonged VF (> 10 minutes), CPR before countershock provides several physiologic benefits. Studies have found that patients with VF of longer than 5 minutes’ duration had better return of spontaneous circulation, survival to hospital discharge, and 1-year survival if ambulance personnel provided 3 minutes of CPR before performing defibrillation than if ambulance personnel performed defibrillation immediately after arriving at the scene; however, some experts question the validity of these results, on the basis of study design.[1]

Epinephrine or Vasopressin? For patients in cardiac arrest, vasopressin (40 units I.V. once only) is a reasonable alternative to epinephrine, at least initially. Vasopressin in the recommended dose is a potent vasoconstrictor. It also has the theoretical advantage over epinephrine of not increasing myocardial oxygen consumption or lactate production in the arrested heart. In out-of-hospital cardiac arrests, vasopressin was found to be comparable to epinephrine when the rhythm was ventricular fibrillation or pulseless electrical activity but superior to epinephrine for patients in asystole.

Improving Outcome after Successful Resuscitation Ongoing research continues to look at optimal postresuscitation management strategies to improve neurologic outcome and survival to hospital discharge. Hyperthermia and hyperglycemia compromise postresuscitation neurologic outcome, whereas mild to moderate induced hypothermia appears to improve neurologic outcome and decrease mortality.

more… http://www.medscape.com/viewarticle/506617?rss http://www.medscape.com/viewarticle/506088?rss http://www.medscape.com/viewarticle/506681?rss