local anesthetics - Hamad Medical Corporation

SRPS 10 (18) Pt 2, 2007Outcome StudiesThe outcome of CPR/ACLS is determined to a large extentby the type of cardiac arrest. When the cause of the arrestis asystole or electromechanical dissociation, survival todischarge from hospital is less than 2%. When the causeis ventricular fibrillation, survival is usually 15–25%.The two primary predictors of outcome after cardiacarrest are ventricular fibrillation and the presence of awitness. Survival is much more likely if the cardiacrhythm is ventricular fibrillation. 66 Resuscitation is typicallyunsuccessful when there is a pulseless rhythm.Pulseless rhythms are simple manifestations of catastrophicevents such as cardiac rupture, rupture ofabdominal aortic aneurysm, global cardiac ischemia,pulmonary embolism, and respiratory arrest.Patients who arrest outside the hospital have significantlylower survival rates (4–10%) compared withpatients who arrest while hospitalized. For every minutethat passes from the time of collapse to defibrillation,there is a substantial decrease in survival. Age of thepatient is also a major determinant: patients youngerthan 70 who arrest in-hospital are successfully resuscitated20% of the time, whereas for patients older than 70survival is only 3.4%. 24,67Pepe et al 68 studied how several factors influencedsurvival rates after cardiac arrest. Despite IAC-CPR,vest compression, endotracheal intubation, pharmacologicmanipulation, and other innovations, only earlydefibrillation by electroshock was found to be of valuein increasing long-term survival. While most authorsbelieve that ACLS probably does improve the outcomein cardiac arrest, strong clinical data are lacking. 68AlgorithmsThe following flow charts should be studied and prominentlydisplayed in all environments where patientsgather.23