Koolaid for ROSC

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Byline: Jerry Adler

Consider someone who has just died of a heart attack. His organs are intact, he hasn’t lost blood. All that’s happened is his heart has stopped beating–the definition of “clinical death”–and his brain has shut down to conserve oxygen. But what has actually died?

As recently as 1993, when Dr. Sherwin Nuland wrote the best seller “How We Die,” the conventional answer was that it was his cells that had died. The patient couldn’t be revived because the tissues of his brain and heart had suffered irreversible damage from lack of oxygen. This process was understood to begin after just four or five minutes. If the patient doesn’t receive cardiopulmonary resuscitation within that time, and if his heart can’t be restarted soon thereafter, he is unlikely to recover. That dogma went unquestioned until researchers actually looked at oxygen-starved heart cells under a microscope. What they saw amazed them, according to Dr. Lance Becker, an authority on emergency medicine at the University of Pennsylvania. “After one hour,” he says, “we couldn’t see evidence the cells had died. We thought we’d done something wrong.” In fact, cells cut off from their blood supply died only hours later.

(Moderators edit:Link to the full article - click here -. - Chimpie)
 
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for more info check out WakeEMS.com, or google it. The above article is from Newsweek.
 
Medicine recycles itself. Old practices becomes new again. Hypothermia and Cardiopulmonary Bypass were both popular in the ED in the 1980s. Both still stayed around primarily in Neo/Pedi, but re-emerged to the adult mainstream about 5 years ago.

We do one or both in the Neo/Pedi in the hospital.

We do initiate hypothermia protocols in the ED for some adult cardiac arrests, case by case. Some doctors want to see it initiated for all, but there are other factors to consider.

There have been discussions again about initiating hypothermia protocols on the amubulances, but many do not carry paralytics to control the shivering. I do remember the early 1980s when we were packing ice around the heads of near-drowning victims. No easy task in Florida. Unfortunately in Florida, we have no body of water to chill a person and get the results as they have in Michigan or Minnesota.
 
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The Newsweek link is
http://www.msnbc.msn.com/id/18368186/site/newsweek/

Good article.

I know Duke University is a leader in the research.

Intratracheal cooling is being considered but the liquid perfluorocarbons may not be ready for a prehospital situation at this time.

What are you using to chill the patient?
 
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Thanks Vent for the link.
 
Quite an interesting article, goes along the theory of hypotherima patients rescued from cold deep water.
 
The Newsweek link is
http://www.msnbc.msn.com/id/18368186/site/newsweek/

Good article.

I know Duke University is a leader in the research.

Intratracheal cooling is being considered but the liquid perfluorocarbons may not be ready for a prehospital situation at this time.

What are you using to chill the patient?
To "chill" the patient i was just using some jazz, dim lights, threw him in the lazyboy....HHAHAH. J/K,....

Good link though !!, the FDA apparently has a problem with the fluorocarbon issue and thats the hold up. Much the same as the military once trying to field-test the "hyperoxygenated liquid" for divers to breathe.
 
The liquid perfluorocarbons have been used in the hospital setting for many years especially in neonates with FDA approval. The other area exploring the use of liquid perfluorocarbons is surgery.

We used LiquiVent for ARDS in all the ICUs on several occasions for awhile and then we vested our time, money and effort on other technologies.

This is very expensive and while grants could be obtained for more research to offset the cost, it would be still be costly for the number of codes some busy hospitals have. Cost is now a big factor for determining healthcare. Another example is Nitric Oxide vs Flolan. The preferred or physician preference may not be what the hospital can run cost wise or by their formulary.

http://www.allp.com/fact.htm
 
liquivent for ARDS?,..hmmm interesting, im gonna look that up. I'll admit, im not spun up on all the high-tech approaches for NICU either, i still thought the FDA was keeping the flurocarbon deal a no-go. Wasnt aware it was actually being used,..how much of an impact did it make as far as life-sustaining, or improvement from your experience? in either case i mean, ARDS or NICU application. I know complete medical journals and books have probably been written on this im sure, but, whats your view? im sure the price is through the roof!
 
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