Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation.

CONTEXT: Use of automated external defibrillators (AEDs) by first arriving emergency medical technicians (EMTs) is advocated to improve the outcome for out-of-hospital ventricular fibrillation (VF). However, adding AEDs to the emergency medical system in Seattle, Wash, did not improve survival. Studies in animals have shown improved outcomes when cardiopulmonary resuscitation (CPR) was administered prior to an initial shock for VF of several minutes' duration. OBJECTIVE: To evaluate the effects of providing 90 seconds of CPR to persons with out-of-hospital VF prior to delivery of a shock by first-arriving EMTs. DESIGN: Observational, prospectively defined, population-based study with 42 months of preintervention analysis (July 1, 1990-December 31, 1993) and 36 months of post-intervention analysis (January 1, 1994-December 31, 1996). SETTING: Seattle fire department-based, 2-tiered emergency medical system. PARTICIPANTS: A total of 639 patients treated for out-of-hospital VF before the intervention and 478 after the intervention. INTERVENTION: Modification of the protocol for use of AEDs, emphasizing approximately 90 seconds of CPR prior to delivery of a shock. MAIN OUTCOME MEASURES: Survival and neurologic status at hospital discharge determined by retrospective chart review as a function of early (<4 minutes) and later (> or =4 minutes) response intervals. RESULTS: Survival improved from 24% (155/639) to 30% (142/478) (P=.04). That benefit was predominantly in patients for whom the initial response interval was 4 minutes or longer (survival, 17% [56/321] before vs 27% [60/220] after; P = .01). In a multivariate logistic model, adjusting for differences in patient and resuscitation factors between the periods, the protocol intervention was estimated to improve survival significantly (odds ratio, 1.42; 95% confidence interval, 1.07-1.90; P = .02). Overall, the proportion of victims who survived with favorable neurologic recovery increased from 17% (106/634) to 23% (109/474) (P = .01). Among survivors, the proportion having favorable neurologic function at hospital discharge increased from 71% (106/150) to 79% (109/138) (P<.11). CONCLUSION: The routine provision of approximately 90 seconds of CPR prior to use of AED was associated with increased survival when response intervals were 4 minutes or longer.

Iron status of premenopausal women in a university community and its relationship to habitual dietary sources of protein.

Dietary intake and iron status was evaluated in 52 nonpregnant premenopausal women who were not using Fe supplements. Subjects were separated into three groups based on their habitual consumption of red meat (RM), fish and/or poultry (FP), or lacto-ovovegetarian (LV) sources of protein. No differences were observed among the groups in demographic characteristics (eg, age, height, weight, reported number of menstrual days per year) or total Fe intake. However, those women consuming red meat as their predominant source of protein demonstrated superior Fe status, especially reflected by higher serum ferritin concentrations (RM = 30.5 micrograms/L; FP = 15.6 micrograms/L; and LV = 19.1 micrograms/L). Thus, form rather than amount of dietary Fe appears to be most influential on Fe status; the basis for the distinctly lower Fe stores among heavy users of fish and/or poultry remains to be determined.

Supplement use: vitamin intakes and biochemical indexes in 40- to 108-month-old children.

Intakes and related biochemical indexes of ascorbic acid, thiamin, riboflavin, pyridoxine, vitamin B-12, and folic acid were examined for adequacy in 30 normal children aged 40 to 108 months. Comparisons were made between intake and biochemical index values of children who reported regular use of vitamin supplements and those who reported none. Three-day food records provided nutrient intake data; blood samples, drawn following an overnight fast, were analyzed for biochemical indexes. Student's t-test and the Pearson r were used for comparisons. Mean intakes of most nutrients differed significantly between the supplemented and nonsupplemented groups only when supplements were considered. Mean biochemical indexes differed significantly for riboflavin (p less than .005). Correlations between intakes and respective biochemical indexes were significant for riboflavin (p less than .01) and vitamin B-12 (p less than .01) in the supplemented group and for folate with RBC folate (p less than .005) in the nonsupplemented group. No deficiencies in either group were evident from biochemical indexes; improvement in indexes with supplement use was interpreted as being only relative and not suggestive that such use is beneficial.

Supplementation patterns of Washington State dietitians.

More than 900 dietitians in the state of Washington were surveyed to determine their personal patterns of dietary supplementation. Seventy-five percent of the population responded; of the respondents, nearly 60% reported the use of some nutritional supplement. The most commonly used supplements were multivitamins plus minerals and vitamin C only, with 21% and 19% of the population choosing these supplementation patterns, respectively. Multivitamins (no minerals) and iron only or with vitamin C were each chosen by 6.9% of the population. Other supplement categories were used less often: calcium with or without vitamin D (2.7%), protein only (3%), and extra calories (0%). The most commonly used "miscellaneous" supplement was potassium. Among subgroups of the population, supplement use was most common among pregnant and lactating women and underweight individuals. The few individuals using iron supplements were women, and most of them were under 30 years of age. The majority of users of calcium supplements were women over 50. Although the bases for the observed supplementation patterns were not determined in the present study, speculations can be put forth. In the meantime, it is clear that many dietitians have chosen to utilize some nutritional supplement for personal health.

First trimester serum zinc concentrations in human pregnancy.

Serum zinc concentrations in the 1st trimester of human pregnancy were evaluated in 106 women whose dates of conception were precisely determined by basal body temperature monitoring and human chorionic gonadotropin levels. Data are reported by intervals of postovulatory days. Sera were analyzed for zinc by atomic absorption spectrophotometry after acid digestion. Mean 1st trimester serum zinc concentrations, determined by 20-day increments from ovulation, were 0.97 +/- 0.22, 0.68 +/- 0.14, 0.77 +/- 0.18, and 0.70 +/- 0.15 micrograms/ml; differences between means were significant at p less than 0.005, less than 0.005, and less than 0.01, respectively. These differences could not be related to diet, supplement use, or hematocritic changes. No differences were apparent between diabetic and nondiabetic subjects. Of the 25 samples from women who aborted spontaneously, zinc concentration of seven were lower than interval means.