Cardiopulmonary Resuscitation and Rescue Therapies.

The history of cardiopulmonary resuscitation and the Society of Critical Care Medicine have much in common, as many of the founders of the Society of Critical Care Medicine focused on understanding and improving outcomes from cardiac arrest. We review the history, the current, and future state of cardiopulmonary resuscitation.

Induced Hypothermia to 4.2°C with Neurologically Intact Survival: A Forgotten Case Series.

The lowest recorded core temperature from which a person with accidental hypothermia has survived neurologically intact is 11.8°C in a 2-y-old boy. The lowest recorded temperature from which an adult has been resuscitated neurologically intact is 13.7°C in a 29-y-old woman. The lowest core temperature with survival from induced hypothermia has been quoted as 9°C. We discovered a case series (n=50) from 1961 in which 5 patients with core temperatures below 11.8°C survived neurologically intact. The lowest core temperature in this group was 4.2°C. The authors also presented cardiovascular and other physiologic data at various core temperatures. The patients in the case series showed a wide variation in individual physiological responses to hypothermia. It is not known whether survival from accidental hypothermia is possible with a core temperature below 11.8°C, but this case series suggests that the lower limit for successful resuscitation may be far lower. We advise against using core temperature alone to decide whether a hypothermic patient in cardiac arrest has a chance of survival.

History of cardiopulmonary resuscitation in ancient China: a narrative review.

Modern cardiopulmonary resuscitation (CPR) comprises an open airway, artificial ventilation, chest compressions and, if necessary, defibrillation. CPR has been intensively studied and tested to perfect an integrated and effective resuscitation system in the West. However, CPR efforts in China has been understudied and underreported. CPR has been performed for more than 2000 years in China. As early as the third century BC, a Chinese doctor named Zhongjing Zhang presented a detailed program to save patients from suicide by hanging in the book entitled "Synopsis of the Golden Chamber". Dr. Zhang proposed "not only to save the body, but also to save the spirit", which remains a guiding principle in modern resuscitation: to not only ensure cardiopulmonary recovery but also preserve the brain function. We aim to review and summarize efforts of CPR in China from a historic point of view.

The history of bone marrow in orthopaedic surgery (part I trauma): trepanning, bone marrow injection in damage control resuscitation, and bone marrow aspiration to heal fractures.

PURPOSE: One of the oldest procedures performed by man is trepanning of the bone and yet it was only in the last 40 years that bone marrow aspiration has been used to treat nonunion disorders. MATERIAL AND METHODS: These advances were possible due to improvements in instruments and in techniques to make holes in the bone, an history that began with skull trephinations around 8000-10,000 years ago, and continued with sternum bone marrow injection for trauma resuscitation in the beginning of the twentieth century; this procedure had improved at the beginning of the twenty-first century to allow pelvis bone marrow aspiration for the treatment of nonunion. RESULTS: Trephined skulls from antiquity have been found in many parts of world, showing that trephining was ancient and widespread. Beginning with Neolithic period and the pre-Columbian Andean civilizations, the authors have traced the development of this surgical skill by describing the various surgical tools used to perform holes in the skull. These tools (trephines or trepan) were proposed at the end of the nineteenth century to study the bone marrow. At the beginning of the twentieth century, the sternum became the center of interest for the "in vivo" study of the bone marrow and the fluid injection in the sternum's bone marrow was described for resuscitation from shock during the World War II. With the introduction of plastic catheters and improved cannulation techniques, the need for intraosseous infusion as an alternative route for intravenous access diminished and sometimes abandoned. However, during the mid-1980s, James Orlowski allowed renaissance of the use of intraosseous infusion for paediatric resuscitation. Since then, this technique has become widespread and is now recognized as an alternative to intravenous access in adult emergencies; particularly, the intraosseous access has received class IIA recommendation from the Advanced Trauma Life Support program supported by the American College of Surgeons Committee on Trauma and bone marrow infusion is now recommended for "Damage Control" resuscitation. Although the pelvis bone contains half of the body's marrow volume, it was only in 1950 that the pelvis was proposed as a source for bone marrow aspiration and bone marrow-derived mesenchymal stem cells to improve healing of fractures. CONCLUSION: It will be many years before doing holes in the bone as orthopaedic trauma procedure will be relegated to the annals of history.

Will We Code for Default ECMO?

Cardiopulmonary resuscitation has become the default treatment for all patients who suffer cardiac arrest. The history of how this came to be suggests the clinical and ethical importance of establishing more humane and appropriate indications for extracorporeal membrane oxygenation and other aggressive therapies for patients at the end of life.

A History and Overview of Telecommunicator Cardiopulmonary Resuscitation (T-CPR).

Few events in pre-hospital medicine inspire as much attention and resources as out-of-hospital cardiac arrest (OHCA), yet the survival rate for such events has remained stagnant and unacceptably low. The first links in the chain of survival are early recognition and early CPR; yet EMS services do not arrive to the scene of a medical call for on average 7 minutes. Emergency dispatchers are generally the first trained individuals involved in medical emergencies; they can provide pre-arrival instructions, specifically telecommunicator CPR (T-CPR), and represent the potential to double the bystander CPR rate and increase return of spontaneous circulation. Yet, according to survey data, fewer than half of all public safety answering points (PSAPs) provide any T-CPR and even fewer provide hands-only CPR instruction.1 This article will provide a brief overview, history and introduction to the evidence supporting the use of T-CPR to improve outcomes in OHCA.

What Every Anesthesiologist Should Know About the Manual Resuscitation Bag.

The bag-valve-mask or the manual resuscitation bag is life-saving equipment. This article explains its construction, functioning, and limitations. This article also attempts to clarify some common misconceptions such as whether a resuscitation bag can be used to preoxygenate or provide continuous positive airway pressure or positive end-expiratory pressure and the highest percentage of oxygen that it can deliver.

The National Resuscitation Council, Singapore, and 34 years of resuscitation training: 1983 to 2017.

Training in the modern form of cardiopulmonary resuscitation (CPR) started in Singapore in 1983. For the first 15 years, the expansion of training programmes was mainly owing to the interest of a few individuals. Public training in the skill was minimal. In an area of medical care where the greatest opportunity for benefit lies in employing core resuscitation skills in the prehospital environment, very little was being done to address such a need. In 1998, a group of physicians, working together with the Ministry of Health, set up the National Resuscitation Council (NRC). Over the years, the NRC has created national guidelines on resuscitation and reviewed them at five-yearly intervals. Provider training manuals are now available for most programmes. The NRC has set up an active accreditation system for monitoring and maintaining standards of life support training. This has led to a large increase in the number of training centres, as well as recognition and adoption of the council's guidelines in the country. The NRC has also actively promoted the use of bystander CPR through community-based programmes, resulting in a rise in the number of certified providers. Improving the chain of survival, through active community-based training programmes, will likely lead to more lives being saved from sudden cardiac arrest.

Conhecimento e Interesse sobre Suporte Básico de Vida entre Leigos / Basic Life Support Knowledge and Interest among Laypeople

Os leigos podem salvar vidas ou reduzir sequelas em determinadas situações de emergência, se tiverem conhecimento adequado do Suporte Básico de Vida. Apesar disso, o conhecimento do leigo sobre este tema ainda foi pouco pesquisado no Brasil. Objetivo: Investigar o conhecimento, as possíveis limitações e o interesse dos leigos sobre o Suporte Básico de Vida. Métodos: O instrumento de coleta de dados foi um questionário composto por 30 questões aplicadas a uma amostra de 377 indivíduos. Os testes qui quadrado e t não pareado foram utilizados para verificar possíveis associações entre o conhecimento sobre Suporte Básico de Vida e variáveis socioeconômicas. Resultados: Cerca de 41% dos entrevistados declararam saber o que é Suporte Básico de Vida, mas apenas 5,8% afirmaram que, de fato, sentiam-se preparados para aplicá-lo. Quase a totalidade da amostra considerou esse conhecimento importante, e 89,9% fariam um treinamento sobre Suporte Básico de Vida. A média de respostas corretas da amostra foi 37,8% ± 18,1%, observando-se maior conhecimento entre aqueles com maior escolaridade (38,6% ± 18,3%; p = 0,014) e que tinham realizado algum treinamento prévio em Suporte Básico de Vida (43,5% ± 17,8%; p = 0,002). Conclusão: Os leigos reconhecem sua relevância no atendimento inicial de vítimas em certas situações de emergência e, embora tenham interesse em aprender o Suporte Básico de Vida, carecem de meios de capacitação.

Laypeople can save lives and reduce sequelae in certain emergency situations if they have enough knowledge on Basic Life Support. Nonetheless, laypeople's knowledge of Basic Life Support has been little investigated in Brazil. Objective: To investigate laypeople's knowledge, possible barriers and interest regarding Basic Life Support. Methods: A questionnaire containing 30 questions was applied to a sample of 377 individuals. Chi-square and unpaired t test were calculated to assess the possible association between socioeconomic variables and the knowledge of Basic Life Support. Results: Approximately 41.1% of the sample affirmed they knew what Basic Life Support was, but only 5.8% felt prepared to perform it, if needed. Nearly the whole sample considered the knowledge of Basic Life Support important and 89.9% would be available to take a Basic Life Support learning course. The average of correct answers was 37.8% ± 18.1%. This value was higher among subjects with higher level of education (38.6% ± 18.3%; p = 0.014) and among those who reported previous training in Basic Life Support (43.5% ± 17.8%; p = 0.002). Conclusions: Laypeople recognize their role in the immediate care given to victims of certain emergency situations. Even though laypeople lack training, they show interest in learning Basic Life Support.

Reanimación cardiopulmonar: Reseña histórica / Cardiopulmonary resuscitation: Historical review

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[A brief history of resuscitation - the influence of previous experience on modern techniques and methods]. / Krótka historia resuscytacji - wplyw doswiadczen z przeszlosci na obecnie stosowane techniki i metody.

Cardiopulmonary resuscitation (CPR) is relatively novel branch of medical science, however first descriptions of mouth-to-mouth ventilation are to be found in the Bible and literature is full of descriptions of different resuscitation methods - from flagellation and ventilation with bellows through hanging the victims upside down and compressing the chest in order to stimulate ventilation to rectal fumigation with tobacco smoke. The modern history of CPR starts with Kouwenhoven et al. who in 1960 published a paper regarding heart massage through chest compressions. Shortly after that in 1961Peter Safar presented a paradigm promoting opening the airway, performing rescue breaths and chest compressions. First CPR guidelines were published in 1966. Since that time guidelines were modified and improved numerously by two leading world expert organizations ERC (European Resuscitation Council) and AHA (American Heart Association) and published in a new version every 5 years. Currently 2010 guidelines should be obliged. In this paper authors made an attempt to present history of development of resuscitation techniques and methods and assess the influence of previous lifesaving methods on nowadays technologies, equipment and guidelines which allow to help those women and men whose life is in danger due to sudden cardiac arrest.