Public access defibrillation in the Caribbean: the time has come

Recent technological advances in resuscitation equipment and procedures have opened the door for some developing countries to consider implementing early defibrillation programmes. This is particularly true in the Caribbean, where urbanisation is rapidly altering the nature of health problems, and public expectations of healthcare delivery is rapidly rising. However before an SCD victim in the Caribbean can expect to be rescued from a cardiac arrest there is much work to be done. 'Core ACLS' courses that emphasise the critical aspects of ACLS, coupled with widespread teaching programmes aimed at educating the general public about cardiovascular resuscitation, should be initiated. Before full advantage can be taken of recent technological advances, and emergency medical systems can become a reality in the Caribbean, a comprehensive approach to the introduction of resuscitative practices should be considered (AU)

Cardiac asystoles in preterm infants: are these a risk factor for SIDS? - abstract

In spite of significant advances in perinatal/neonatal care, preterm infants remain at high risk for unexplained death in infancy. Using continous documented monitoring as a predischarge screen for persistance of apneas and bradycardias in preterm infants (mean GA 30.5 weeks) prior to hospital discharge, 21 of 332 infants (6.3 per cent) had asystolic events defined as cardiac pauses > 3 seconds. All affected infants had a history of O2 desaturation < 85 per cent and/or colour change in the weeks prior to event monitor screening. Concurrent 72-hour Holter monitoring confirmed sinus pauses of 3 - 10 seconds. Echocardiogram revealed pulmonary artery branch stenosis in 9 of the 21 infants, but no other structural abnormalities. Gastroesophageal reflux was diagnosed by pH probe and/or Milk-Scan in all 21 infants; clinical symptoms improved after specific therapy but asystoles and bradycardias persisted. All infants were followed with home monitoring until asystole-free for 2 months. Asystoles decreased with age: with a mean of 33.7 events/wk at 36 wks post-conceptional age, 24.7 at 47 wks and only 1 infant had asystolic events beyond 58 weeks. Pacemakers were recommended in 3 infants, but only placed in one. None of the infants died. Conclusion: asystolic events occur in preterm infants without significant anatomical cardiac abnormalities and can be diagnosed by continuous documented monitoring. Resolution occurs spontaneously, but long-term cardiology follow-up is necessary to determine later outcome and complications. The significance of these events and their relationship to sudden death in infancy need to be explored (AU)

Sudden cardiac death caused by coronary ostial compression by an aneurysm of the sinus of valsalva

A 22-year-old man was asymptomatic until he died suddenly after being startled. Post-mortem examination was normal except for aneurysmal dilation of the left Sinus of Valsalva, the upper margin of which formed a flap-like ridge, partially occluding the ostium of the left main coronary artery which arose immediately above it. Further compression of this "slit-like" orifice by aneurysmal distention was the proposed cause of myocardial ischaemia and arrhythmic death (AU)

A prospective study of 200 cardiopulmonary arrests at the University Hospital of the West Indies

This is a prospective study of 200 cardio-pulmonary arests, occuring at the University Hospital of the West Indies. There was an 18 per cent successful resuscitation rate but only 7 per cent of survivors left hospital. These results compare favourably wth those from other centres with similar patient populations. There is a need for improvement, however, particularly the continuation of in-service training in cardio-pulmonary resuscitation for all staff members and better selection of patients who are suitable for resuscitation (AU)

Post-cardiac arrest survival of patients following admission to the intensive care unit - abstract

A retrospective study of patients admitted to the Intensibe Care Unit (ICU) at the Uiversity Hospital of the West Indies following a cardiac arrest was undertaken to determine the early and late survival rates. Patient data was collected on forms and inserted in a patient data-base (ICU-DATA) utilising a SWTPC micro-computer system. Pertinent data was retrieved and analysed using the report-writer and sort/merge software programmes respectively. During the 2-year period (1/1/81 to 31/12/82), 51 patient were admitted to the ICU following successful resuscitation of cardiac arrest. There were 32 males and 19 females and their ages ranged from 1 day to 78 years (mean 38.3 years). The secondary diagnosis was as follows:- cardiovascular (10), postoperative (8), central nervous system (7), respiratory (6), diabetes (4), renal failure (3), shock (3), anaemia (2), systemic lupus (1), multiple myeloma (1), not recorded (6). Forty (40) patients, i.e 78.4 per cent, died in the ICU. Their duration of stay ranged from 1 hour to 8 days (mean 1.2). The remaining 11 patients who were discharged from the ICU, 5 died on the convalescent wards and 1 at home. Of the remaining 5 survivors, 2 were lost to follow-up. The other 3 patients are doing well. Hence the overall death rate was 90.1 per cent (AU)

A review of 100 cases of cardiac arrest and the relation of potassium, glucose and haemoglobin levels to survival

One hundred consecutive cases of cardiac arrest were reviewed and compared with similar published series. There were 35 patients resuscitated from whom there were 11 long-term useful survivors in 2 groups where resuscitation was carried out for more than 30 minutes. Nine out of 12 of the eventual survivors were in the group where the anaesthetists arrived at the location of the arrest in less than 4 minutes. There were no survivors from 35 cases in whom initial resuscitation was inadequately carried out by the nurses and the importance of teaching them the basic procedures of resuscitation was stressed. Regular checking and standardization of all equipment was recommended. With one exception, patients with haemoglobin levels below 10 G/100 ml. did not survive. No patients with serum potassium levels above 5.0 mEq/litre survived. A case was made for always checking the blood sugar at cardiac arrest, as there were no survivors from either the hypoglycaemic or hyperglycaemic (above 400 mg./100 ml.) groups of patients (AU)

Cardiac arrest due to the oculocardiac reflex

This is a recorded case of cardiac arrest due to the oculocardiac reflex, assisted by meticulous digitalization. The oculocardiac reflex was elicited by applying a bridle suture to the superior rectus muscle during a routine cataract operation (AU)

Cardiorespiratory resuscitation in the prone position in small children

A method of cardiorespiratory resuscitation in the prone position for small children is described. It is especially recommended for use when the resuscitator is alone and has no equipment. No time is lost in securing or maintaining a clear airway. Circulatory and ventilatory assistance is rendered simultaneously and continuously (AU)

Heart disease in Jamaica

The cardiac cases admitted to an adult male and female ward of the University College Hospital of the West Indies during 1956 and '57 have been analysed and the autopsy incidence of heart lesions in the first 1258 cases seen in the Pathology Department of the University College of the West Indies has been reviewed. (AU)

Cardiac arrest complicating surgery

A case of cardiac arrest, occuring during an abdominal operation and treated successfully by cardiac massage, is recorded. The importance of early diagnosis and immediate treatment with cardiac massage by a trans thoracic approach is stressed. Factors probably responsible for the recovery of this patient are suggested. The site of the thoractomy incision and drainage of the chest are discussed. (AU)

Prevention and treatment of some anaesthetic accidents

An account is given of some of the principles complications of anaesthesia with appropriate prophylaxis, treatment and prognosis. The importance of hypoxia, as a factor in serious accidents, is emphasized (AU)