786DR MASHOOQUE ALI DASTI

MD CARDIOLOGY

IntroductionAt least 350 000 people will suffer cardiac arrest each year in the United States, 1 every 90 seconds. Many will then undergo cardiopulmonary resuscitation (CPR) by bystanders and emergency medical services in a desperate attempt to restore life. Numerous studies report that the majority of these efforts will not succeed.

Prolonged anoxia, the inability to restore spontaneous circulation,

neurological devastation, and other complications combine to

limit survival. It is a young science; the term "CPR" was first publicized less than 50 years ago

Highlights of the History of Cardiopulmonary Resuscitation (CPR)1740 The Paris Academy of Sciences officially recommended mouth-to-mouth resuscitation for drowning victims.

1767 The Society for the Recovery of Drowned Persons became the first organized effort to deal with sudden and unexpected death.

1891  Dr. Friedrich Maass performed the first equivocally documented chest compression in humans.

1903 Dr. George Crile reported the first successful use of external chest compressions in human resuscitation.

1904 The first American case of closed-chest cardiac massage was performed by Dr. George Crile.

1954 James Elam was the first to prove that expired air was sufficient to maintain adequate oxygenation.

1956 Peter Safar and James Elam invented mouth-to-mouth resuscitation.

1957 The United States military adopted the mouth-to-mouth resuscitation method  to revive unresponsive victims.

1960 Cardiopulmonary resuscitation (CPR) was developed. The American Heart Association started a program to acquaint physicians with close-chest cardiac resuscitation and became the forerunner of CPR training for the general public.

1963 Cardiologist Leonard Scherlis started the American Heart Association's CPR Committee, and the same year, the American Heart Association formally endorsed CPR.

1966 The National Research Council of the National Academy of Sciences convened an ad hoc conference on cardiopulmonary resuscitation.  The conference was the direct result of requests from the American National Red Cross and other agencies to establish standardized training and performance standards for CPR.

1972 Leonard Cobb held the world's first mass citizen training in CPR in Seattle, Washington called Medic 2.  He helped train over 100,000 people the first two years of the programs.

1981 A program to provide telephone instructions in CPR began in King County, Washington.  The program used emergency dispatchers to give instant directions while the fire department and EMT personnel were en route to the scene.  Dispatcher-assisted CPR  is now standard care for dispatcher centers throughout the United States.

• . Dr Claude Beck and his first cardiac defibrillator. Images courtesy of Dr Igor Efimov (left) and the Dittrick Medical History Center, Case Western Reserve University (right).

Statistics of SurvivalModern published studies of resuscitation for cardiac arrest (all cardiac rhythms) show rates of survival to hospital discharge

that range from 1% to 25% for outpatients and 0% to 29% for inpatients. Of the first 20 patients who underwent closed-chest cardiac

massage, only 3 had ventricular fibrillation, and yet 14 survived

the arrest (70% survival). In 1953, a review of 1200 in-hospital cardiac arrests reported that, despite only 11% having ventricular fibrillation, 28% were resuscitated to "permanent survival.“

OUTCOME OF CADIOPULMONARY RESUSCITATION AFTER MYOCARDIAL INFARCTION

AT DEWAN MUSHTAQUE

• AIMS OF STUDY • The purpose of this study was to evaluate in

hospital survival of the patients with myocardial infarction who developed cardiac arrest and to look into the factors associated with success rate of CPR.

BACKGROUND The major determinants of survival after in-Hospital cardiac arrest depend upon1. The time factors, 2. How quickly it is initiated,3. Extent of resuscitation efforts,4. Expertness of team 5. Dedication of CPR team.

METHOD

• Prospective study of 126 patients admitted in DEWAN MUSHTAQUE coronary care unit who received advance cardiac life support protocol after in hospital cardiac arrest during the period of six months.

• Short term survival (Return of spontaneous respiration and circulation) and hospital survival at the time of discharge were measured.

• In addition, factors affecting the outcome of CPR age, gender, and duration of CPR, associated arrhythmias, defibrillation and TPM implantation were also taken in account.

•

RESULTS

• Over all 45 out of 126 patients (33%) who received advance cardiopulmonary life support, survived to hospital discharge.

• Survival was better in male i.e. 37% versus 26% in female. • young age group showed better survival 40% in age range of

30 to 49 years, 33% in 50 to 69 years and 28% in 70years and older.

• Survival rate was 86% when CPR duration was less than 10 minutes, at the 15 minutes 48% and at 20 minutes CPR time, 25% patients survived. Only 13% patients survived at CPR time of 30 minutes.

RESULTSSurvival was 42% for patients with VF and 68% in those presenting VT, 61% in fast AF with heamodynamically instability. 29% patients having TPM implantation survived of cardiac arrest. Poor survival in patients of cardiac arrest presenting with new development of LBBB i.e. 18% , best in inferior wall STEMI ( 32%) , intermediate in anterior wall STEMI ( 28%). Total of 30 patients in cardiogenic shock had cardiac arrest and 17% resuscitated successfully

CONCLUSION

Survival was highest for patients with primary cardiac arrest, with short CPR duration, young age, male with tachyarrhythmia. Patients who experienced cardiac arrest at cardiac emergency room have better survival. Survival was poor in patients with cardiogenic shocks, CPR duration more than 20 minutes