1,721,001 research outputs found
Lay resuscitation in the German rescue system. Some basic information
No full textTo bridge the time gap without therapeutic intervention until the EMS team arrives, lay rescuers should be trained in performing adequate cardiopulmonary resuscitation (CPR). About 2 million people attend CPR courses each year in Germany. However, it has been observed that the skills acquired by the attendees already begin to deteriorate shortly thereafter. As an alternative, efforts are currently underway to assess telephone-guided resuscitation performed by bystanders on site following instruction received via telephone. Use of automated external defibrillators by helpers first on the scene is considered to be another option. Initial experience has shown, however, that little use is made of the equipment located at heavily frequented areas (airports, railroad stations, etc.). At these locations it seems to make more sense to train the first responders (police force, fire department). Further measures need to be implemented to improve the actual assistance rendered in terms of quality and quantity
Attempted CPR in nursing homes - life-saving at the end of life?
No full textAim: We studied the course and success rate of cardiopulmonary resuscitation (CPR) attempted on nursing home residents by a physician-staffed pre-hospital advanced cardiac life support (ACLS) team. Methods: Ambulance records of nursing home residents from Goettingen/Germany who had a cardiac arrest were examined retrospectively. Results: During a seven-year period (1992-1998) the ACLS team was called to 71 residents (mean age 81.8 years) who sustained cardiac arrest. In 25 patients no CPR was attempted: 20 were pronounced dead by the arriving emergency physician, though only in 7 patients obvious clinical signs of death were present. Five patients suffered from a continuous deterioration of their health status and the ACLS team arrived after the process of dying had already started. No CPR attempt was initiated. The ACLS team performed CPR on 46 nursing home residents. In 33 patients (72% of CPR attempts) no return of spontaneous circulation (ROSC) was achieved. in three patients (6%) palpable pulse returned only transiently. Ten patients (22%) who showed ROSC were transported to the hospital. Six patients died within 24 hours after having been admitted to the hospital, two patients within the next 8 days. Two patients survived to hospital discharge. The first was a 79-year old woman who returned to the nursing home after three weeks and survived severely mentally disabled another five days. The second was an 83-year-old man who was hospitalised for 20 days, returned in a persistent vegetative state to the nursing home and died 10 months later. A comparison of the arrest characteristics demonstrated that in patients with successful CPR there was a higher incidence of a witnessed collapse, bystander CPR, ventricular fibrillation and cardiac aetiology of arrest. Conclusion: In a high rate (35%) the ACLS team with the emergency physician at the scene withheld CPR efforts in nursing home residents. Even if CPR was initiated, the benefits were very limited with only two patients (4,3%) surviving severely disabled to hospital discharge
Bystander CPR - results and consequences from the Gottingen Pilot Project.
No full textFrom 1985-1989 a community project on bystander CPR was carried out, including about 20.000 citizens; most of them were male, more than 60% younger than 30 years old. Evaluation of knowledge and skills among former participants in a realistic setting showed that six months after the course 66,7% performed according to AHA standards, after 12 and 24 months 23,5 % and 21,1%. Using a more practical method of interpreting the data with emergency medicine based criteria it could be found that after 6 months 90% of the test persons were able to improve the chances of survival in a real emergency, after 12 and 24 months each time 70%. The CPR data bank which has been established with the start of the project actually includes 1.825 cases. 70% of the patients on whom resuscitation has been attempted were male, mean age was 62 years. 60% of the emergencies occurred in the patients' home, 84% were witnessed, and 74% of cardiac origin. In 28% bystanders initiated resuscitation prior to the arrival of the EMS. Out of all 1.825 CPR attempts 35,8% were primarily successful, that means patients could be admitted to hospital with a spontaneous circulation. Following bystander CPR 42,4% of patients had VF in the first ECG compared with 29,1% in the non-bystander group. Corresponding to this out of the bystander group 43,6% of patients could be admitted to hospital with a spontaneous circulation, out of the non-bystander group only 32,7%. The positive effects of bystander CPR continued during the clinical course: 31,8% out of this group could be discharged without neurologic damage compared with 7,2% out of the non-bystander group. As far as long-term survival is concerned five years after discharge 53% of patients in whom bystanders had initiated resuscitation were alive and 31 % out of the non-bystander group. As an attempt to increase the rate of bystander initiated CPR and thus to bridge the interval without therapy a project on telephone CPR has started just recently
The Gottingen AED model
No full textDespite all progress in modern medicine, cardiovascular diseases and sudden cardiac death remain one of the most frequent causes of death worldwide. As most of these cases are caused by ventricular fibrillation which rapidly reduces the chances of survival and can only be terminated by defibrillation, inclusion of lay rescuers to perform basic life support and use automated external defibrillators (AED) within a public access defibrillation program according to the latest recommendations of the European Resuscitation Council (ERC) and the American Heart Association (AHA) has become a milestone in combating sudden cardiac death. Nevertheless, correct AED placement is still a problem and implementing a public access defibrillation (PAD) program is still a challenge. Therefore, performing needs assessment should be the first step in identifying suitable sites for placement of AEDs. The Gottingen AED model provides a tool for such a needs assessment. However, this model certainly needs further validation
To resuscitate or not? The emergency physician's decision in the prehospital setting
No full textObjective: To identify factors affecting the decision to withhold resuscitative attempts or to terminate cardiopulmonary resuscitation (CPR) in the prehospital setting. Methods: In a physician-based emergency medical system (EMS) standardised interviews with the emergency physicians were performed within 24 hours after unsuccessful or withheld CPR-efforts. Results: Over a period of one year 170 prehospital cardiac arrests were evaluated. 47 patients (28%) were declared dead on arrival by the emergency physician. The decision to withhold CPR was based on obvious clinical signs of death (32 patients) or the diagnosis of cardiac arrest due to severe trauma (8 patients). In 4 cases the terminal state of a fatal illness was the emergency physician's criterion not to initiate resuscitative efforts. In 3 patients an extended response time (more than 10 minutes) was mentioned, in combination with a primary rhythm of either asystole or electromechanical dissociation and additional information given by the family doctor. In 123 patients CPR was attempted. In 72 cases (59%) resuscitative efforts were terminated as no return and stabilisation of spontaneous circulation was achieved. In 58 patients the decision to stop CPR was based on the evidence of cardiac death. Additional criteria for the termination of the resuscitation attempt were the duration of CPF, an extended response time, pre-existing diseases, age, pupillary status, missing brain stem reflexes, the reason of cardiac arrest, information given by the family or the family doctor and secondarily evolving signs of death. In 14 patients the emergency physicians reported that their decision to terminate CPR was primarily based on these co-factors, the evidence of cardiac death was not explicitly mentioned in these cases. Conclusion: In the pre-hospital setting the decision to withhold or to withdraw CPR is mostly based on reliable criteria such as obvious clinical signs of death, fatal trauma or evidence of cardiac death. Nevertheless, in a small but considerable number of cases exceptions to this rule are made by emergency physicians
Practical examination of first aid bystanders performing Basic Life Support
No full textBackground. First aid by bystanders is an essential part in the care for emergency patients. Till now it seemed to be the weakest part of the "chain of survival" and for that first-aid defines the strength of this concept. Methods: We investigated 118 participants of a standardized course of immediate life-saving treatment. That type of course is addressed to lay people and is mandatory to get the German driving license. We looked for the practical skills directly following the course by a standardized basic life scenario for evaluation using a recording CPR manikin (Laerdal(TM)). Results: Most of the participants failed the practical test directly following the course (64.4%). Significant better results in performing CPR were reached by participants having taken part in such training courses frequently in the past. Discussion:We could show that repeating first-aid courses may improve better practical results by lay people. This repeating of first-aid courses may strengthen an essential part of the chain of survival. The mandatory first aid course seems not to be appropriate to create or increase the motivation of participants to initiate CPR in a real emergency situation [5,6,14]
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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