Abstract:
OBJECTIVE:The purpose of this study is to: 1) describe a newly mechanism of blood flow to the brain during cardiopulmonary resuscitation using the impedance threshold device in a piglet model of cardiac arrest, and 2) describe the survival benefits in humans of applying all of the highly recommended changes in the 2005 guidelines related to increasing circulation during cardiopulmonary resuscitation, including use of the impedance threshold device, from six emergency medical services systems in the United States. DESIGN:Animal studies prospective trial with each piglet serving as its own control. Historical controls were used for the human studies. SUBJECTS:Piglets and patients with out-of-hospital cardiac arrest. INTERVENTIONS:Piglets (10-12 kg) were treated with an active (n = 9) or sham (n = 9) impedance threshold device after 6 mins of ventricular fibrillation. Humans were treated with cardiopulmonary resuscitation per the American Heart Association 2005 guidelines and the impedance threshold device. MEASUREMENTS AND MAIN RESULTS: ANIMALS:The primary endpoint in the piglet study was carotid blood flow which increased from 59 mL/min without an impedance threshold device to 91 mL/min (p = 0.017) with impedance threshold device use. Airway pressures during the chest recoil phase decreased from -0.46 mm Hg to -2.59 mm Hg (p = 0.0006) with the active impedance threshold device. Intracranial pressure decreased more rapidly and to a greater degree during the decompression phase of cardiopulmonary resuscitation with the active impedance threshold device. Humans: Conglomerate quality assurance data were analyzed from six emergency medical services systems in the United States serving a population of approximately 3 million people. There were 920 patients treated for cardiac arrest after implementation of the 2005 American Heart Association guidelines, including impedance threshold device use, and 1750 patients in the control group during the year before implementation. Demographics were similar between the two groups. Survival to hospital discharge was 9.3% in the control group versus 13.6% in the intervention group. The odds ratio, 95% confidence interval, and p value were 1.54 (1.19-1.99) and p = 0.0008, respectively. This survival advantage was conferred to patients with a presenting cardiac arrest rhythm of ventricular fibrillation (28.5% vs. 18.0%, p = 0.0008). CONCLUSIONS:Use of the impedance threshold device in piglets increased carotid blood flow and coronary and cerebral perfusion pressures and reduced intracranial pressure during the decompression phase of cardiopulmonary resuscitation at a faster rate than controls, resulting in a longer duration of time when intracranial pressures are at their nadir. Patients in six emergency medical services systems treated with the impedance threshold device together with the renewed emphasis on more compressions, fewer ventilations, and complete chest wall recoil had a nearly 50% increase in survival rates after out-of-hospital cardiac arrest compared with historical controls.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Aufderheide TP,Alexander C,Lick C,Myers B,Romig L,Vartanian L,Stothert J,McKnite S,Matsuura T,Yannopoulos D,Lurie Kdoi
10.1097/ccm.0b013e31818a7e56subject
Has Abstractpub_date
2008-11-01 00:00:00pages
S397-404issue
11 Suppleissn
0090-3493issn
1530-0293journal_volume
36pub_type
杂志文章,多中心研究abstract:OBJECTIVES:Conflict is common between physicians and surrogate decision makers around end-of-life care in ICU. Involving experts in conflict management improve outcomes, but little is known about what differences in conflict management styles may explain the benefit. We used simulation to examine potential differences ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001583
更新日期:2016-05-01 00:00:00
abstract:OBJECTIVE:Procalcitonin has been advocated as a specific biomarker for bacterial infection. We performed this study to determine whether accuracy of procalcitonin for diagnosis of postoperative bacterial infection is affected by renal function after aortic surgery. DESIGN:Single-center prospective study. SETTING:Univ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181692966
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVES:Swallowing disorders may be associated with adverse clinical outcomes in patients following invasive mechanical ventilation. We investigated the incidence of dysphagia, its time course, and association with clinically relevant outcomes in extubated critically ill patients. DESIGN:Prospective observational t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002765
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVE:When a patient is incompetent, the family is often considered to be a natural surrogate. The doctors' responsiveness to family wishes may vary. We explored if doctors' personal characteristics were associated with responsiveness to the relatives' wishes when admission to the intensive care unit (ICU) is consi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181958409
更新日期:2009-02-01 00:00:00
abstract::Among Gram-positive pathogens, Staphylococcus aureus is the leading cause of death from nosocomial pneumonia. The bacterium developed progressive resistance to beta-lactams, and methicillin-resistant strains emerged in the 1980s. In consequence, vancomycin has become the drug of choice for treatment of this infection ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200104001-00005
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVE:To review the rationale for the regionalization of adult critical care and discuss how lessons from the trauma experience may be relevant to this debate. DESIGN:Narrative review and opinion. RESULTS:Variation in the quality of critical care among hospitals has prompted calls for regionalization of care for ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e31818c37b2
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate the long-term cardiopulmonary outcome at ages 10-15 yrs following neonatal extracorporeal membrane oxygenation (ECMO). The specific aims of the study were to assess baseline aerobic capacity, cardiac function, and pulmonary function in neonatal ECMO survivors using gr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000084856.00372.CE
更新日期:2003-09-01 00:00:00
abstract:OBJECTIVE:The pathogenesis of acute gastric stress ulceration in the seriously ill is uncertain, and any role of Helicobacter pylori infection is unknown. We aimed to assess the relationship between H. pylori serological status and stress ulceration in seriously ill patients, as well as H. pylori serological status in ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199907000-00010
更新日期:1999-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the frequency and clinical correlates of ultrafilterable hypomagnesemia in neonates admitted to the neonatal intensive care unit (ICU). DESIGN:Prospective, observational study. SETTING:Massachusetts General Hospital and Mount Auburn Hospital. PATIENTS:A total of 117 patients (84 neonatal ICU pa...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199405000-00017
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVE:Critical care medicine trainees and faculty must acquire and maintain the skills necessary to provide state-of-the art clinical care to critically ill patients, to improve patient outcomes, optimize intensive care unit utilization, and continue to advance the theory and practice of critical care medicine. Thi...
journal_title:Critical care medicine
pub_type: 指南,杂志文章,实务指引
doi:10.1097/01.CCM.0000104916.33769.9A
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVES:To compare in the same patient with septic shock, respective effects of epinephrine, norepinephrine, and the combination of norepinephrine and dobutamine (5 microg/kg/min) on systemic hemodynamic parameters and gastric mucosal perfusion using gastric tonometry and laser-Doppler flowmetry techniques. DESIGN:...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199905000-00021
更新日期:1999-05-01 00:00:00
abstract:OBJECTIVES:The association between tobacco smoke exposure and critical illness is not well studied, largely because obtaining an accurate smoking history from critically ill patients is difficult. Biomarkers can provide quantitative data on active and secondhand cigarette smoke exposure. We sought to compare cigarette ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181fa4196
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVE:To review recent advances in the use of transforming growth factor (TGF)-beta in acute lung injury and to apply this knowledge to understanding the pathophysiology of this syndrome. DATA SOURCES AND STUDY SELECTION:Published research and review articles in the English language related to the role of TGF-beta...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000057901.92381.75
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVE:The association between cigarette smoke exposure and the acute respiratory distress syndrome in patients with the most common acute respiratory distress syndrome risk factors of sepsis, pneumonia, and aspiration has not been well studied. The goal of this study was to test the association between biomarker-co...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001089
更新日期:2015-09-01 00:00:00
abstract::A high rate of death from septic shock persists despite general improvements in care. The relative failure of mechanistically based therapies in various clinical trials should also trigger a reconsideration of such mechanistic approaches. Despite reversion of shock by hydrocortisone, the similar death rate compared wi...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181f23dc4
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVE:To determine whether any advantage exists using racemic epinephrine instead of the more potent and less expensive levo(1)-epinephrine in the treatment of postextubation laryngeal edema. DESIGN:Prospective, double-blind, randomized study. SETTING:Pediatric intensive care unit in a university teaching hospita...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1994-10-01 00:00:00
abstract:OBJECTIVE:To study the epidemiology, style of management, and outcome of intensive care patients with acute renal failure requiring replacement therapy in Australia. DESIGN:Prospective epidemiologic study. SETTING:Australian adult intensive care units providing acute renal replacement therapy. PATIENTS:Adult intensi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200110000-00010
更新日期:2001-10-01 00:00:00
abstract::The ability of ACTH-(1-24) to prolong survival and to extend the deadline for effective blood reinfusion has been studied in a model of lethal hypovolemic shock in the rat. Anesthetized rats were bled to a mean arterial pressure of 18 to 25 mm Hg and then subjected to one of the following iv treatments: a) saline; b) ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199008000-00014
更新日期:1990-08-01 00:00:00
abstract:OBJECTIVES:To determine whether glucose utilization and metabolic substrate (glucose and fat) oxidation could be manipulated in patients with secondary multiple organ dysfunction syndrome. DESIGN:Prospective study. SETTING:Intensive care units (ICU) of two university hospitals. PATIENTS:Eight adults free of hepatic ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199501000-00014
更新日期:1995-01-01 00:00:00
abstract:OBJECTIVE:Conventional outcomes research provides only percentage risk of such end points as mortality rate, utilization of resources, and/or broad groupings of multiple organ system dysfunction. These prognostications generally are not applicable to individual patients. The purpose of the present study was to determin...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200205000-00014
更新日期:2002-05-01 00:00:00
abstract:OBJECTIVE:Oxygenation measured 24 hours after acute respiratory distress syndrome onset more accurately stratifies risk, relative to oxygenation at onset, in both children and adults. However, waiting 24 hours is problematic, especially for interventions that are more efficacious early in the disease course. We aimed t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002958
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVE:Our goal was to demonstrate explicitly that lower-frequency positive-pressure ventilation not only preserves adequate oxygenation and acid-base status in hemorrhagic states, but also that "normal" or higher respiratory rates significantly compromise hemodynamics, even with moderate degrees of hemorrhage. DES...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000134264.88332.37
更新日期:2004-09-01 00:00:00
abstract:OBJECTIVE:The mortality of critically ill patients associated with intestinal ischemia/reperfusion remains very high, which results from multiorgan dysfunction or failure due to intestinal injury induced by intestinal ischemia/reperfusion. This study was carried out to investigate whether intestinal ischemia/reperfusio...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182546855
更新日期:2012-08-01 00:00:00
abstract:OBJECTIVE:Intracranial pressure (ICP) monitoring is frequently used in intensive care treatment of patients with intracranial hemorrhage. Data demonstrating an improved outcome from this intervention are lacking. We analyzed standardized mortality ratios in patients with and without ICP monitoring to determine its effi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000065270.53951.9E
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVES:Although the majority of sudden cardiac arrests occur in patients with ischemic heart disease, the effect of therapeutic hypothermia on arrhythmia susceptibility during acute global ischemia is not well understood. While both ischemia and severe hypothermia are arrhythmogenic, patients undergoing therapeutic...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31825fd39d
更新日期:2012-11-01 00:00:00
abstract:OBJECTIVES:Extracorporeal membrane oxygenation is increasingly used in the management of severe acute respiratory distress syndrome. With extracorporeal membrane oxygenation, select patients with acute respiratory distress syndrome can be managed without mechanical ventilation, sedation, or neuromuscular blockade. Publ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003354
更新日期:2018-11-01 00:00:00
abstract::The Hemoccult slide test is used frequently to test for the presence of occult blood in samples of gastric juice obtained from critically ill patients. The purpose of this study was to investigate the accuracy of this test to determine the presence of blood in human gastric juice at various pH values. Gastric aspirate...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198210000-00016
更新日期:1982-10-01 00:00:00
abstract:OBJECTIVE:To examine the pulmonary and cardiac function of children who survived an episode of acute hypoxemic respiratory failure. DESIGN:Descriptive cohort analysis. SETTING:Pediatric clinical research center of a university hospital. PATIENTS:Utilizing the criteria of PaO2 < 75 torr (< 10 kPa) with an FIO2 of > 0...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199601000-00024
更新日期:1996-01-01 00:00:00
abstract::Reimbursement policies are a critical step in the incorporation of new technologies and therapies into the clinical armamentarium. Reimbursement is an umbrella concept describing the process to manage and pay for healthcare services, including benefit coverage, coding, and payment processes. The technologies and servi...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181aa6288
更新日期:2009-07-01 00:00:00
abstract:OBJECTIVES:Extracorporeal membrane oxygenation is used to stabilize severe cardiocirculatory and/or respiratory failure. However, extracorporeal membrane oxygenation is associated with a coagulopathy characterized by thromboembolic and hemorrhagic complications. This study aimed to characterize the pathomechanism of th...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004286
更新日期:2020-05-01 00:00:00