Comparison of High-Dose Epinephrine Versus Standard-Dose Epinephrine in Adult Cardiac Arrest in the Prehospital Setting

1996 ◽  
Vol 11 (3) ◽  
pp. 219-222 ◽  
Author(s):  
Richard D. Carvolth ◽  
Ardith J. Hamilton
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Ventricular Fibrillation ◽  
Hospital Admission ◽  
Standard Dose ◽  
Test Group ◽  
Prehospital Setting ◽  
Adult Patients ◽  
Control Group ◽  
High Dose

AbstractObjective:To compare the efficacy of high-dose epinephrine (HDE) with standard-dose epinephrine (SDE) in the management of cardiac arrest in adults in the prehospital setting.Hypothesis:The use of HDE will improve the outcome of adult patients in cardiac arrest.Methods:In a general population of 700,000 persons, in a mixed geographical area of 2,200 square miles, a 12-month retrospective study of SDE and a 12-month prospective trial of HDE were conducted involving adult patients in cardiac arrest in the prehospital setting. Treatment was provided by paramedic-level clinicians. In the control group, patients were treated according to existing American Heart Association cardiac resuscitation guidelines using SDE (defined as 1.0 mg boluses to a maximum dose of 4 mg). In the test group, the same guidelines were revised to use HDE (defined as a rapid sequence of 5, 10, and 15 mg boluses to a total dose of 30 mg).Results:The control group included 594 patients; the test group consisted of 580 patients. The overall survival rate to hospital admission in the control group was 14.5% (84 patients) and in the test group 15.3% (89 patients). The survival rate to hospital discharge in the control group was 4.9% (29 patients) versus 4.8% (28 patients) in the test group. For patients whose initial rhythms were ventricular fibrillation, survival to admission in the control group was 20.4% (39 patients) versus 24.4% (43 patients) in the test group. Survival to discharge for patients with ventricular fibrillation in the control group was 8.9% (17 patients) versus 10.8% (19 patients) in the test group.Conclusion:There was no statistically significant difference in overall rate of survival to hospital admission or discharge between patients treated with SDE and those treated with HDE, regardless of the initial rhythm.

scholarly journals Post‐Cardiac Arrest Hydrocortisone Use Ameliorates Cardiac Mitochondrial Injury in a Male Rat Model of Ventricular Fibrillation Cardiac Arrest

2021 ◽  
Author(s):  
Min‐Shan Tsai ◽  
Chien‐Hua Huang ◽  
Chen‐Hsu Wang ◽  
Hsaio‐Ju Cheng ◽  
Shih‐Ni Wu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Rat Model ◽  
Low Dose ◽  
Myocardial Damage ◽  
Male Rat ◽  
Control Group ◽  
High Dose ◽  
Mitochondrial Injury ◽  
Treatment Groups

Background Steroid use after cardiac arrest has been reported to improve survival and neurological outcome in cardiac arrest survivors. The study aimed to evaluate the effect of post‐arrest hydrocortisone use on myocardial damage and cardiac mitochondrial injury in a rat model of ventricular fibrillation cardiac arrest. Methods and Results Ventricular fibrillation cardiac arrest was induced and left untreated for 5 minutes in adult male Wistar rats. Cardiopulmonary resuscitation and electric shocks were then applied to achieve return of spontaneous circulation (ROSC). Successfully resuscitated animals were randomized into 3 groups: control, low‐dose hydrocortisone (2 mg/kg), and high‐dose hydrocortisone (8 mg/kg). The low‐dose hydrocortisone and high‐dose hydrocortisone (treatment) groups received intravenous hydrocortisone immediately after ROSC and the control group received saline as placebo. Each group consisted of 15 animals. Within 4 hours of ROSC, both treatment groups showed a higher cardiac output than the control group. At the fourth hour following ROSC, histological examination and transmission electron microscopy demonstrated less myocardial damage and mitochondrial injury in the animals treated with hydrocortisone. In the treatment groups, hydrocortisone mitigated the acceleration of Ca 2+ ‐induced mitochondrial swelling and suppression of complex activity observed in the control group. At the 72nd hour after ROSC, a significantly higher proportion of animals treated with hydrocortisone survived and had good neurological recovery compared with those given a placebo. Conclusions Hydrocortisone use after cardiac arrest may mitigate myocardial injury and cardiac mitochondrial damage and thus improve survival, neurological and histological outcomes in a rat model of ventricular fibrillation cardiac arrest.

Abstract 15210: Do Idiopathic Ventricular Fibrillation and Brugada Syndrome Patients Have Favor Outcomes in the Targeted Temperature Management Era?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Eisuke Kagawa ◽  
Masaya Kato ◽  
Noboru Oda ◽  
Eiji Kunita ◽  
Michiaki NAGAI ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Ventricular Fibrillation ◽  
Brugada Syndrome ◽  
Cardiac Dysfunction ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Circulatory Support ◽  
Idiopathic Ventricular Fibrillation ◽  
Coronary Syndrome

Introduction: Idiopathic ventricular fibrillation (IVF) including Brugada syndrome (BS) is one of causes of cardiac arrest without prior overt cardiac dysfunction. Hypothesis: We assessed the hypothesis that patents of IVF had favor outcomes than those of non-IVF after cardiac arrest treated with targeted temperature management (TTM). Methods: Patients who were treated with TTM after cardiac arrest between 2000 and 2019 were enrolled in the study. Patients were divided into 2 groups according to whether the patients were diagnosed as IVF or not. The patients treated with TTM were routinely performed coronary angiography. Results: Among the study patients (N = 306), 35 (11%) patients were IVF and 7 were BS. The patients of the IVF group were significantly younger (median 53 y vs. 64 y) than those of the non-IVF group. The prevalence of initial rhythm was shockable (69% vs. 47%, P = 0.02) was significantly higher in the patients of the IVF group than those of the non-IVF group. Among the patients in the non-IVF group, 114 patients (42%) were diagnosed as acute coronary syndrome and 93 patients (35%) were treated with coronary revascularization. The prevalence of male sex (77% vs 74%, P = 0.70) and witnessed to arrest (80% vs. 81%, P = 0.87), and low-flow time (29 min vs. 38 min [20 - 43 min vs. 21 - 52 min, P = 0.15]) were similar between the 2 groups. The prevalence of performing extracorporeal resuscitation (9% s 43%, P < 0.001) were lower in the patients of the IVF group. The 8-y survival rate were shown in the figure. All of the BS patients were witnessed arrest and were discharged without severe neurological deficit. The IVF as the cause of arrest was independently associated with 8-y survival. Conclusions: The patients of IVF had favor outcomes than those of non-VF. One of causes may be the lower prevalence of requiring extracorporeal circulatory support due to less cardiac dysfunction. The patients of BS had the tendency toward higher survival rate than those of non-BS IVF patients.

Abstract P14: Estradiol Does Not Improve Survival and Hemodynamic Parameters in Male Piglets after Hemorrhage and Ventricular Fibrillation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Egidijus Semenas ◽  
Lars Wiklund
Keyword(s):  
Gender Differences ◽  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hemorrhagic Shock ◽  
Repeated Measures ◽  
Troponin I ◽  
Control Group ◽  
Hemodynamic Parameters ◽  
Start Time ◽  
Arterial Blood

Introduction: Gender differences in organ functions and survival have been described in animal models of trauma and hemorrhagic shock. The female gender is associated with better cardiac, hepatic and immune functions compared to males after hemorrhagic shock. However, data about gender differences in hypovolemic normothermic cardiac arrest is lacking. Hypothesis: We hypothesized that the estradiol given during cardiopulmonary resuscitation (CPR) will improve survival and hemodynamic response in hypovolemic cardiac arrest and subsequent CPR. Methods: Twenty anesthetized male piglets (with a weight of 25.7 ± 1.7 kg [mean ± SD]) were bled 30% via the right femoral artery to a mean arterial blood pressure of 35 mm during 15 minutes. In the end of bleeding period estradiol group (n=10) received 17â-estradiol 50 ìg/kg intravenously, while the control group received no estradiol (n=10). Later all piglets were subjected to 4 min of untreated ventricular fibrillation followed by up to 15 min of open chest CPR. At 5 min of cardiac arrest piglets received vasopressin 0.4 U/kg, amiodarone 0.5 mg/kg, and hypertonic-hyperoncotic solution 3 ml/kg infusion for 20 minutes. Internal defibrillation was attempted from 8 min of cardiac arrest to achieve restoration of spontaneous circulation (ROSC). The experiment was terminated at 3 hours after initial resuscitation. Data were analyzed using Fisher’s exact test, Kaplan-Meier and repeated measures ANOVA methods. Results: All piglets were successfully resuscitated. No significant differences were observed in survival between the groups (p=0.24). All piglets needed dobutamine infusion and no differences were observed in either total dobutamin dose, or infusion start time (p=0.05). No significant changes were observed in any hemodynamic parameters (p>0.05). Troponin I levels did not differ between groups (p>0.75). Conclusions: Intravenous 17â-estradiol does not improve survival and hemodynamic parameters in male piglets after experimental hypovolemic cardiac arrest.

scholarly journals Immediate Loading of Implant-Supported Single Crowns after Conventional and Ultrasonic Implant Site Preparation: A Multicenter Randomized Controlled Clinical Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Claudio Stacchi ◽  
Teresa Lombardi ◽  
Domenico Baldi ◽  
Calogero Bugea ◽  
Antonio Rapani ◽  
...  
Keyword(s):  
Survival Rate ◽  
Test Group ◽  
Site Preparation ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Marginal Bone Loss ◽  
One Year ◽  
And Control ◽  
Implant Site Preparation ◽  
Single Crowns

Aim. To compare implant survival rate and marginal bone loss (MBL) of immediately loaded single implants inserted by using ultrasonic implant site preparation (UISP) (test) and conventional rotary instrumentation (control). Methods. Two single implants were inserted for each patient: after randomization, test site was prepared by using an ultrasonic device (Piezosurgery Touch, Mectron, Italy) and control site was prepared by using the drills of the selected implant system (Premium AZT, Sweden & Martina, Italy), until reaching a final diameter of 3 mm in both groups. Identical implants (3.8x11.5 mm) were inserted in all sites at crestal level. Impressions were taken and screwed resin single crowns with platform-switched provisional abutments were delivered with 48 hours. Periapical radiographs were taken at provisional crown insertion (T0), 6 months (T1) and one year (T2) after prosthetic loading to measure MBL. All data were tested for normality and subsequently analyzed by paired samples t-test and forward multiple linear regression. Results. Forty-eight patients were treated in six centers with the insertion of ninety-six implants (48 test; 48 control). Four implants in four patients failed within the first six months of healing (two in test group; two in control group; no difference between groups). Forty patients (age 60.1±10.7 years; 22 female, 18 male) were included in the final analysis. Mean MBL after six months of loading was 1.39±1.03 mm in the test group and 1.42±1.16 mm in the control group (p>0.05) and after one year was 1.92±1.14 mm and 2.14±1.55 mm in test and control, respectively (p>0.05). Conclusions. No differences in survival rate and MBL were demonstrated between UISP and conventional site preparation with rotary instruments in immediately loaded dental implants: UISP, with its characteristics of enhanced surgical control and safety in proximity of delicate structures, may be used as a reliable alternative to the traditional drilling systems.

scholarly journals High-Dose Adrenaline in Adult In-Hospital Asystolic Cardiopulmonary Resuscitation: A Double-Blind Randomised Trial

1993 ◽  
Vol 21 (2) ◽  
pp. 192-196 ◽  
Author(s):  
J. Lipman ◽  
W. Wilson ◽  
S. Kobilski ◽  
J. Scribante ◽  
C. Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Side Effects ◽  
Cardiopulmonary Resuscitation ◽  
Standard Dose ◽  
Randomised Trial ◽  
High Dose ◽  
Double Blind ◽  
To Receive

Forty intensive care unit patients requiring cardiopulmonary resuscitation were randomised to receive either the standard dose of adrenaline (1 mg every five minutes) or high-dose adrenaline (10 mg every five minutes). In the majority of patients, overwhelming sepsis was the major contributing factor leading to cardiac arrest. In this group of patients no difference could be detected in response to high-dose adrenaline compared with the standard dose. Although no side-effects were noted with this high dose of adrenaline, more investigation is required prior to its routine use in cardiopulmonary resuscitation.

scholarly journals Immunomodulatory Effect of a Salvia plebeia R. Aqueous Extract in Forced Swimming Exercise-induced Mice

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2260
Author(s):  
Jinseop Shin ◽  
Ok-kyung Kim ◽  
Shintae Kim ◽  
Donghyuck Bae ◽  
Jeongmin Lee ◽  
...  
Keyword(s):  
Aqueous Extract ◽  
Test Group ◽  
Forced Swimming ◽  
Immunomodulatory Effect ◽  
Swimming Exercise ◽  
Raw264.7 Cells ◽  
Control Group ◽  
High Dose ◽  
No Production ◽  
Exercise Induced

This study investigated the immunomodulatory effect of Salvia plebeia R. aqueous extract (FIE-SP, SPW) in forced swimming exercise-induced mice and the immunostimulatory effects on Raw264.7 cells. Mice were randomly assigned to four groups: the control group (CON), the forced swimming test group (FST), and two FIE-SP groups (low and high dose of FIE-SP). Compared with the control group, the FIE-SP groups showed significantly increased ratios of T lymphocyte surface markers CD4+/CD8+ and major histocompatibility complex (MHC)I/MHCII, as well as increased concentrations of immunoglobulin (Ig)A and IgG. FIE-SP groups significantly increased Th1 cytokines and decreased Th2 cytokines compared with negative control exercise-induced mice. Conversely, the immunostimulatory effects of FIE-SP significantly increased phagocytic activities, nitric oxide (NO) production, and pro-inflammatory cytokines tumor necrosis factor alpha (TNF-α) and interleukin (IL)-1β in Raw264.7 cells. Furthermore, FIE-SP increased natural killer (NK) cell activities and cytokines (IL-12) in splenocytes compared with the CON group. These results indicated that FIE-SP supplementation could prevent imbalanced immune states and produce immunostimulatory effects to support innate immunity.

Efficacy, toxicity, and applicability of high-dose sequential chemotherapy as adjuvant treatment in operable breast cancer with 10 or more involved axillary nodes: five-year results.

1997 ◽  
Vol 15 (6) ◽  
pp. 2312-2321 ◽  
Author(s):  
A M Gianni ◽  
S Siena ◽  
M Bregni ◽  
M Di Nicola ◽  
S Orefice ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Standard Dose ◽  
Treated Group ◽  
Multicenter Trial ◽  
Control Group ◽  
High Dose ◽  
Axillary Nodes ◽  
Major Toxicity ◽  
Nonhematologic Toxicity

PURPOSE To assess the efficacy, toxicity, and applicability of high-dose therapy administered as adjuvant initial treatment to women with breast cancer with extensive nodal involvement. PATIENTS AND METHODS Sixty-seven patients with stage II to III breast cancer involving > or = 10 axillary nodes received a novel high-dose sequential (HDS) regimen, including the high-dose administration of three non-cross-resistant drugs (cyclophosphamide, methotrexate, and melphalan) given within the shortest interval of time as possible with hematologic and nonhematologic toxicity. RESULTS Sixty-three patients completed the program as planned, one patient died of acute toxicity, and three patients were switched to standard-dose adjuvant therapy. After a median follow-up duration of 48.5 months and a lead follow-up of 78 months, actuarial relapse-free survival for all 67 registered patients is 57% and overall survival is 70%, respectively. Comparison with a historical control group of 58 consecutive patients showed a significantly superior rate of freedom from relapse for the HDS-treated group (57% v 41%, respectively), in particular when two subgroups of patients, more homogeneous for their number of involved nodes, were compared (65% v 42%). Overall, treatment was of short duration (median, 70 days), required a median of 32 days of hospital stay, and was associated with only a few severe side effects (the most distressing being oral mucositis after melphalan therapy). CONCLUSION HDS therapy emerges as an effective and applicable regimen, whose major toxicity was occasional. Final assessment of its value in a randomized, multicenter trial is presently underway.

Immediate Loading of Unsplinted Implant Retained Mandibular Overdenture: A Randomized Controlled Clinical Study

2019 ◽  
Vol 45 (5) ◽  
pp. 378-389 ◽  
Author(s):  
Ahmad Kutkut ◽  
Mohamed Rezk ◽  
Dominique Zephyr ◽  
Dolphus Dawson ◽  
Robert Frazer ◽  
...  
Keyword(s):  
Clinical Study ◽  
Survival Rate ◽  
Test Group ◽  
Immediate Loading ◽  
Control Group ◽  
Gingival Index ◽  
Implant Survival ◽  
Implant Stability ◽  
Treatment Groups ◽  
Implant Survival Rate

This clinical study aimed to clinically and radiographically compare the implant survival rate and peri-implant tissue response between immediate and delayed loading protocols for unsplinted implant retained mandibular overdentures. Twenty patients were enrolled to participate in this study. Each subject was randomly assigned to 1 of 2 treatment groups: test group patients' implants (n = 10), which were immediately loaded, and control group patients' implants (n = 10), which were conventionally loaded. Locator abutments were torqued to 15 Ncm at delivery. Attachments were picked up intraorally immediately after implant placement for the test group and at 3 months for the control group, and 3-lb retention inserts were placed. Marginal bone levels based on cone beam computed tomography fixed reference points were recorded at baseline and 12 months. Modified plaque index, gingival index, and implant stability quotients were recorded at baseline, 3 months, and 12 months. After 12 months, implant survival rate was 100% in both groups. Marginal bone levels, keratinized mucosa, modified plaque index, and gingival index were significantly different among the groups at 3- and 12-month intervals, whereas no significant differences were found in implant stability quotients between the groups. The fact that implant survival rate was 100% in both treatment groups suggests that, within the limitations of this study, immediate loading protocol for unsplinted implant retained mandibular complete overdenture is as predictable, safe, and successful as the delayed loading protocol. Implementing the immediate loading protocol for mandibular implant retained overdentures could shorten treatment time, which could lead to better patient's satisfaction.

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