R ESUSCITATION C ARDIOPULMONARY

C ARDIOPULMONARY

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C HRISTOPHER P. C ANNON , MD S

ERIES

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MD

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Heart Disease Diagnosis and Therapy: A Practical Approach, Second Edition, edited by Gabriel M. Khan,

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, Julian F.

R. Paton,

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,

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h

D

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Surgical Management of Congestive Heart Failure, edited by James C. Fang,

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CT of the Heart: Principles and Applications, edited by U. Joseph Schoepf,

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Nuclear Cardiology, The Basics: How to Set Up and Maintain a Laboratory, by Frans J. Th.

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BS

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Minimally Invasive Cardiac Surgery, Second Edition, edited by Daniel J. Goldstein,

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Cardiovascular Health Care Economics, edited by William S. Weintraub,

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Platelet Glycoprotein IIb/IIIa Inhibitors in Cardiovascular Disease, Second Edition, edited by A. Michael Lincoff,

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Cardiac Repolarization: Bridging Basic and Clini- cal Science, edited by Ihor Gussak,

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MD

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Primary Angioplasty in Acute Myocardial Infarc- tion, edited by James E. Tcheng,

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Management of Cardiac Arrhythmias, edited by Leonard I. Ganz,

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Medicine and Therapeutics, edited by

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MD

, 2001

C ARDIOPULMONARY

R ESUSCITATION

Edited by

J ^OSEPH P. O ^RNATO , ^MD , ^FACP , ^FACC , ^FACEP M ^ARY A ^NN P ^EBERDY , ^MD , ^FACC

Departments of Emergency Medicine and Internal Medicine

(Cardiology), Virginia Commonwealth University Health

System, Richmond, VA

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Cardiopulmonary resuscitation / edited by Joseph P. Ornato, Mary Ann Peberdy.

p. ; cm. -- (Contemporary cardiology) Includes bibliographical references and index.

ISBN 1-58829-283-5 (alk. paper) 1. CPR (First aid)

[DNLM: 1. Cardiopulmonary Resuscitation. WG 205 C2677 2005] I. Ornato, Joseph P.

II. Peberdy, Mary Ann. III. Series: Contemporary cardiology (Totowa, N.J. : Unnumbered) RC87.9.C3732 2005

616.1'025--dc22

2004002774

P ^REFACE

v

More than 460,000 Americans die each year from sudden, unexpected cardiac arrest.

Despite the fact that there have been more than 50 years of scientific, experimental, and clinical studies since the introduction of modern cardiopulmonary resuscitation (CPR) by researchers at Johns Hopkins University in the 1950s, survival remains dismal. Only 1 out of 5 adults survive in-hospital, and less than 1 in 10 survive out-of-hospital, cardiac arrest. Thus, there is ample room for further discovery and enhancement of resuscitative interventions.

CPR is at best an inexact science spanning many different specialties and medical disci- plines. Organizations such as the American Heart Association, the Canadian Heart and Stroke Foundation, the European Resuscitation Council, and the International Liaison Committee on Resuscitation develop and publish guidelines for resuscitation approxi- mately every 5 years. Many of the authors in this book are active members of these organizations and contribute regularly to these international guidelines documents. The purpose of Cardiopulmonary Resuscitation is to provide physicians, nurses, paramedics, and other members of the in- or out-of-hospital emergency response team with the latest information on the science and practice of CPR. Unlike the American Heart Association Guidelines in Cardiopulmonary Resuscitation and Emergency Cardiovascular Care or the Advanced Cardiac Life Support textbook, Cardiopulmonary Resuscitation explores the physiology behind current state-of-the-art clinical resuscitation in depth.

Generous portions of this book translate resuscitation physiology and principles into practical bedside recommendations, clinical tips, and expert techniques. The collective wisdom of the authors—an international, stellar group of resuscitation thought leaders—

on how best to approach difficult resuscitation decisions should be of great benefit to in- or out-of-hospital resuscitation team members. The book reviews major ongoing re- search in resuscitation science that will likely affect the next set of international resus- citation guidelines. Finally, there is an extensive discussion of ethical issues surrounding resuscitation of both children and adults.

Cardiopulmonary Resuscitation is dedicated to the countless victims of sudden, unexpected cardiac arrest, and to their families, friends, and loved ones. If our readers can learn from this book even one new, practical technique that can save a life, our efforts will not have been in vain.

Joseph P. Ornato,

MD

,

FACP

,

FACC

,

FACEP

Mary Ann Peberdy,

MD

,

FACC

C ^ONTENTS

vii

Preface ... v

Contributors ... xi

Value-Added eBook/PDA ... xv

1 History of the Science of Cardiopulmonary Resuscitation ... 1

Mickey S. Eisenberg 2 Epidemiology of Sudden Death ... 11

Russell V. Luepker 3 Prevention of Sudden Cardiac Death ... 21

Joseph E. Marine 4 Physiology of Ventilation During Cardiac Arrest ... 39

Andrea Gabrielli, A. Joseph Layon, and Ahamed H. Idris 5 Management of Ventilation During Resuscitation ... 95

Marsh Cuttino 6 Management of Airway Obstruction ... 111

Michael R. Sayre 7 Etiology, Electrophysiology, Myocardial Energy Mechanics, and Treatment of Bradyasystole ... 123

Charles E. Cady and Tom P. Aufderheide 8 Pulseless Electrical Activity ... 147

John M. Field 9 Chest Compression Technique: A Neglected Key to Success in Cardiopulmonary Resuscitation ... 155

Charles F. Babbs 10 Alternate Cardiopulmonary Resuscitation Devices and Techniques ... 177

Henry Halperin and Barry K. Rayburn 11 Training Adults to Perform Cardiopulmonary Resuscitation: What Works? ... 199

Barbara Riegel, Lars Wik, and Alidene Doherty 12 External Defibrillation ... 211

Gregory P. Walcott, Cheryl R. Killingsworth, and Raymond E. Ideker 13 Public Access Defibrillation ... 229

Vincent N. Mosesso, Jr., Mary M. Newman,

and Kristin R. Hanson

viii Contents

14 Pacing During Cardiac Arrest ... 245 Allan S. Jaffe and Utpal H. Pandya

15 Therapeutic Hypothermia in the Treatment of Cardiac Arrest ... 253 Benjamin S. Abella, Terry L. Vanden Hoek, and Lance B. Becker

16 Percutaneous Cardiopulmonary Bypass As an Adjunctive

Strategy for Resuscitation: The State of the Art ... 269 Catherine Cooper and Bruce D. Spiess

17 Principles of Drug Delivery During CPR ... 275 Edgar R. Gonzalez, Joseph A. Grillo, Lih-Jen Wang,

and Jeffrey Rosenblatt

18 Pharmacological Resuscitation Interventions ... 287 Wanchun Tang, Shijie Sun, and Max Harry Weil

19 Use of Vasopressor Drugs in Cardiac Arrest ... 305 Anette C. Krismer, Norman A. Paradis, Volker Wenzel,

and John Southall

20 Buffer Therapy ... 335 Martin von Planta

21 Anti-Arrhythmic Drugs and Cardiac Resuscitation ... 351 Brian Olshansky, Pamela Nerheim, and Richard E. Kerber

22 Electrolyte Disturbances and Cardiopulmonary Resuscitation ... 377 Domenic A. Sica

23 Cardiac Arrest in Pregnancy ... 395 Alison A. Rodriguez and Gary A. Dildy, III

24 Cardiolpulmonary Resuscitation Following Drowning ... 407 Jerome H. Modell and Andrea Gabrielli

25 Cardiopulmonary Resuscitation and Early Management

of the Lightning Strike Victim ... 425 Mary Ann Cooper and Sara Ashley Johnson

26 Hypothermic Cardiac Arrest ... 437 Daniel F. Danzl

27 Cardiopulmonary Resuscitation in Trauma ... 455 Rao R. Ivatury and Kevin R. Ward

28 Monitoring Techniques During Resuscitation ... 475 Kevin R. Ward, R. Wayne Barbee, and Rao R. Ivatury

29 Myocardial Dysfunction Postresuscitation ... 503 Alejandro Vasquez and Karl B. Kern

30 Postresuscitation Cerebral Dysfunction: Prevention

and Treatment ... 523 Antonio E. Muñiz

31 Pediatric Cardiopulmonary Resuscitation ... 609

Robert A. Berg and Vinay M. Nadkarni

ix Contents 32 In-Hospital Resuscitation ... 641

Mary Ann Peberdy

33 Successful Systems for Out-of-Hospital Resuscitation ... 649 Paul E. Pepe, Lynn P. Roppolo, and Leonard A. Cobb

34 Animal Models of Resuscitation ... 683 Kevin R. Ward and R. Wayne Barbee

35 Design of Clinical Trials Related to Medical Emergencies ... 695 Alfred Hallstrom

36 Ethics in Resuscitation ... 713 Antonio E. Muñiz

37 The Future of Cardiopulmonary Resuscitation: Combination

Therapy ... 741 Joseph P. Ornato

Index ... 749

C ONTRIBUTORS

B

ENJAMIN

S. A

BELLA

,

MD

,

MP

hil • Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, IL

T

OM

P. A

UFDERHEIDE

,

MD

• Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI

C

HARLES

F. B

ABBS

,

MD

,

P

h

D

• Department of Basic Medical Sciences, Purdue University, West Lafayette, IN

R. W

AYNE

B

ARBEE

,

P

h

D

• Department of Emergency Medicine, VCU Reanimation Engineering Shock Center, Virginia Commonwealth University Medical Center, Richmond, VA

L

ANCE

B. B

ECKER

,

MD

,

FAHA

• Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, IL

R

OBERT

A. B

ERG

,

MD FAAP

,

FCCM

• Department of Pediatrics, University of Arizona College of Medicine, Tucson, AZ

C

HARLES

E. C

ADY

,

MD

• Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI

L

EONARD

A. C

OBB

,

MD

,

FACP

• Department of Medicine (Cardiology), University of Washington School of Medicine; Medic One Support Group, Harborview Medical Center, Seattle, WA

C

ATHERINE

C

OOPER

,

MD

• Department of Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA

M

ARY

A

NN

C

OOPER

,

MD

• Departments of Bioengineering and Emergency Medicine, University of Illinois, Chicago, IL

M

ARSH

C

UTTINO

,

MD

• Department of Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, VA

D

ANIEL

F. D

ANZL

,

MD

• Department of Emergency Medicine, University of Louisville, Louisville, KY

G

ARY

A. D

ILDY

, III,

MD

• Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA

A

LIDENE

D

OHERTY

,

RN

,

BSN

• University of Washington Medical Center, Seattle, WA M

ICKEY

S. E

ISENBERG

,

MD

,

P

h

D

• Department of Medicine, University of Washington,

Seattle, WA

J

OHN

M. F

IELD

,

MD

• Division of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, PA

A

NDREA

G

ABRIELLI

,

MD

• Division of Critical Care Medicine, Department

of Anesthesiology, University of Florida College of Medicine, Gainesville, FL E

DGAR

R. G

ONZALEZ

,

P

harm

D

,

FASHP

• Nevada College of Pharmacy, Henderson, NV J

OSEPH

A. G

RILLO

,

P

harm

D

• Center for Drug Evaluation and Research, US Food

and Drug Administration, Rockville, MD

A

LFRED

H

ALLSTROM

,

P

h

D

• Department of Biostatistics, University of Washington, Seattle, WA

H

ENRY

H

ALPERIN

,

MD

,

MA

• Departments of Medicine, Radiology, and Biomedical Engineering, Johns Hopkins University, Baltimore, MD

xi

xii Contributors

K

RISTIN

R. H

ANSON

,

BA

,

EMT

• National Center for Early Defibrillation, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA R

AYMOND

E. I

DEKER

,

MD

,

P

h

D

• Division of Cardiovascular Disease, University

of Alabama at Birmingham, Birmingham, AL

A

HAMED

H. I

DRIS

,

MD

• Division of Emergency Medicine, Department of Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX

R

AO

R. I

VATURY

,

MD

• Division of Trauma and Critical Care Surgery, Departments of Surgery, Emergency Medicine, and Physiology, VCU Reanimation Engineering Shock Center,Virginia Commonwealth University Medical Center, Richmond, VA A

LLAN

S. J

AFFE

,

MD

• Cardiovascular Division, Departments of Medicine, Laboratory

Medicine, and Pathology, Mayo Medical School, Rochester, MN

S

ARA

A

SHLEY

J

OHNSON

,

MD

• Department of Emergency Medicine, MacNeal Hospital, Berwin, IL

R

ICHARD

E. K

ERBER

,

MD

• Cardiology Division, University of Iowa College

of Medicine; Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA

K

ARL

B. K

ERN

,

MD

• Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ

C

HERYL

R. K

ILLINGSWORTH

,

DVM

,

P

h

D

• Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL

A

NETTE

C. K

RISMER

,

MD

• Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria

A. J

OSEPH

L

AYON

,

MD

,

FACP

• Division of Critical Care Medicine, Departments of Anesthesiology, Surgery, and Medicine, University of Florida College of Medicine, Gainesville Fire Rescue Service, Gainesville, FL

K

ARL

H. L

INDNER

• Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria

R

USSELL

V. L

UEPKER

,

MD

,

MS

• Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN

J

OSEPH

E. M

ARINE

,

MD

• Cardiology Division, Johns Hopkins Bayview Medical Center, Baltimore, MD

J

EROME

H. M

ODELL

,

MD

• Department of Anesthesiology, University of Florida College of Medicine and University of Florida College of Veterinary Medicine, Gainesville, FL

V

INCENT

N. M

OSESSO

, J

R

.,

MD

,

FACEP

• National Center for Early Defibrillation, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA

A

NTONIO

E. M

UÑIZ

,

MD

,

FACEP

,

FAAP

,

FAAEM

• Departments of Emergency Medicine and Pediatrics, Virginia Commonwealth University Medical Center, Richmond, VA V

INAY

M. N

ADKARNI

,

MD

,

FAAP

,

FCCM

• Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA

P

AMELA

N

ERHEIM

,

MD

• Division of Cardiology, University of Iowa Hospitals, Iowa City, IA

M

ARY

M. N

EWMAN

,

BS

• National Center for Early Defibrillation, Department of

Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA

B

RIAN

O

LSHANSKY

,

MD

• Division of Cardiac Electrophysiology, University of Iowa Hospitals, Iowa City, IA

J

OSEPH

P. O

RNATO

,

MD

,

FACP

,

FACC

,

FACEP

• Departments of Emergency Medicine and Internal Medicine (Cardiology), Virginia Commonwealth University Medical Center, Richmond, VA

U

TPAL

H. P

ANDYA

• Department of Medicine, Mayo Clinic and College of Medicine, Rochester, MN

N

ORMAN

A. P

ARADIS

,

MD

• Departments of Emergency Medicine, Surgery, and Medicine, University of Colorado Health Sciences Center, Denver, CO

M

ARY

A

NN

P

EBERDY

,

MD

,

FACC

• Departments of Emergency Medicine and Internal Medicine (Cardiology), Virginia Commonwealth University Medical Center, Richmond, VA

P

AUL

E. P

EPE

,

MD

,

FACEP

,

FACP

,

FCCM

• Emergency Medicine, Internal Medicine, Surgery and Public Health, University of Texas Southwestern Medical Center;

The Parkland Health and Hospital System; and Dallas Metropolitan BioTel (EMS) System, Dallas, TX

B

ARRY

K. R

AYBURN

,

MD

• Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL

B

ARBARA

R

IEGEL

,

DNS

c ,

RN

,

CS

,

FAAN

• School of Nursing, University of Pennsylvania, Philadelphia, PA; Sharp HealthCare, San Diego, CA

A

LISON

A. R

ODRIGUEZ

,

MD

• Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA

L

YNN

P. R

OPPOLO

,

MD

• Department of Emergency Medicine, University of Texas Southwestern Medical Center and The Parkland Health and Hospital System;

Dispatch Operations, Dallas, TX

J

EFFREY

R

OSENBLATT

,

P

harm

D

• Nevada College of Pharmacy, Henderson, NV M

ICHAEL

R. S

AYRE

,

MD

• Department of Emergency Medicine, Good Samaritan

Hospital, Cincinnati, OH

D

OMENIC

A. S

ICA

,

MD

• Section of Clinical Pharmacology and Hypertension, Division of Nephrology, Virginia Commonwealth University, Richmond, VA

J

OHN

S

OUTHALL

,

MD

• Department of Emergency Medicine, Maine Medical Center, Portland, ME

B

RUCE

D. S

PIESS

,

MD

,

FAHA

• Department of Anesthesiology, VCU Reanimation Engineering Shock Center, Virginia Commonwealth University Medical Center, Richmond, VA

S

HIJIE

S

UN

,

MD

,

FCCM

• Institute of Critical Care Medicine, Palm Springs, CA; and Keck School of Medicine, University of Southern California, Los Angeles, CA W

ANCHUN

T

ANG

,

MD

,

FCCP

,

FCCM

• Institute of Critical Care Medicine, Palm Springs;

and Keck School of Medicine, University of Southern California, Los Angeles, CA T

ERRY

L. V

ANDEN

H

OEK

,

MD

• Department of Emergency Medicine, University

of Chicago, Chicago, IL

A

LEJANDRO

V

ASQUEZ

,

MD

• Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ

M

ARTIN VON

P

LANTA

,

MD

• University of Basel, Basel, Switzerland

G

REGORY

P. W

ALCOTT

,

MD

• Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL

xiii Contributors

L

IH

-J

EN

W

ANG

,

MS

,

P

harm

D

,

BCPS

• Columbus Regional Medical Center, Columbus, GA K

EVIN

R. W

ARD

,

MD

• Departments of Emergency Medicine and Physiology, VCU

Reanimation Engineering Shock Center, Virginia Commonwealth University Medical Center, Richmond, VA

M

AX

H

ARRY

W

EIL

,

MD

,

P

h

D

,

MACP

,

FACC

,

M

aster

FCCP

,

FCCM

• Institute of Critical Care Medicine, Palm Springs, CA; and Keck School of Medicine, University of Southern California, Los Angeles, CA

V

OLKER

W

ENZEL

• Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria

L

ARS

W

IK

,

MD

• Norwegian Competence Center for Emergency Medicine, Institute for Experimental Medical Research, Ulleval University Hospital, Oslo, Norway

xiv Contributors

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