The potential beneficial effects of beta adrenergic blockade in the treatment of ventricular fibrillation

Cardiac arrest remains a major medical emergency in Western societies, with ventricular fibrillation being the initial rhythm in a significant proportion of cases. Adrenaline is generally accepted to improve the resuscitation outcome, since it improves coronary and cerebral blood flow during cardiopulmonary resuscitation, but several detrimental effects have been associated with its use, most of which are thought to be mediated by its beta adrenergic properties. Several animal studies suggest that beta adrenergic blockade during resuscitation, is associated with increased rates of resuscitation and improved post-resuscitation myocardial function. This article reviews the presence and function of beta-adrenoceptor subtypes in the intact and diseased human myocardium, as well as the differences observed in beta(1)- and beta(2) adrenoceptor subtypes in different species. (C) 2009 Elsevier B.V. All rights reserved

Lipomatous hypertrophy of the interatrial septum: A pathological and clinical approach

Lipomatous hypertrophy of the interatrial septum (LHIS) is a rare benign disorder that is characterized by accumulation and deposition of fat in the interatrial septum. Its etiology is still unknown, despite the theories that have been suggested. It usually occurs in older, obese people with a higher incidence in women. In most cases, it remains asymptomatic, thus its diagnosis is rarely made during a person’s lifetime and it is made incidentally or during autopsy. LHIS can cause atrial arrhythmias, obstructive flow symptoms and sometimes death. The diagnosis of LHIS can be made by the use of imaging techniques, with the best results given by multislice-CT (MSCT) scanning. Surgical intervention is usually avoided and the best management is early diagnosis, reassurance and inactivity. However, in cases of severe superior vena cava obstruction or intractable rhythm disturbance, surgical excision is performed together with reconstruction of the interatrial septum. (c) 2007 Elsevier Ireland Ltd. All rights reserved

Reviewing myocardial silent ischemia: Specific patient subgroups

Silent myocardial ischemia (SMI) is a relatively common, yet poorly understood, clinical entity. The most accurate means of detecting SMI and the precise treatment endpoints remain unclear. However, the presence of SMI correlates with the likelihood of future adverse cardiac events. Evidence suggests that patients at high risk of severe cardiac ischemia, even with the absence of symptoms, derive the greatest benefit from an aggressive diagnostic and therapeutic approach. This paper is giving a detailed review of SMI in regards to specific patient subgroups, i.e. populations with diabetes mellitus, hypertension, elderly patients, post-revascularization patients, women, the suggested screening procedures for each subgroup, as well as the emersion of new markers for the selection of high-risk patients for screening. (c) 2007 Elsevier Ireland Ltd. All rights reserved

Atenolol in combination with epinephrine improves the initial outcome of cardiopulmonary resuscitation in a swine model of ventricular fibrillation

Study Objectives: The aim of the present study was to assess whether a beta-adrenergic blocking agent such as atenolol, administered during cardiopulmonary resuscitation, would improve initial resuscitation success. Methods: Ventricular fibrillation was induced in 20 Landrace/Large White piglets, which were left untreated for 8 minutes before attempted resuscitation with precordial compression, mechanical ventilation, and electrical defibrillation. Animals were randomized into 2 groups (10 animals each) to receive saline as placebo (20 mL dilution, bolus) + epinephrine (0.02 mg/kg) (group A) or atenolol (0.05 mg/kg per 20 mL dilution, bolus) + epinephrine (0.02 mg/kg) (group B) during cardiopulmonary resuscitation. Electrical defibrillation was attempted after 10 minutes of ventricular fibrillation. Results: Nine animals in group B restored spontaneous circulation in comparison to only 4 in group A. Aortic systolic and diastolic pressures as well as coronary perfusion pressure were significantly increased during cardiopulmonary resuscitation in group B. Furthenuore, postresuscitation heart rate of the atenolol-treated group was significantly decreased. Conclusions: A beta-adrenergic blocking agent, when administered during cardiopulmonary resuscitation, significantly improves initial resuscitation success and increases blood and coronary perfusion pressures during cardiopulmonary resuscitation. (C) 2008 Elsevier Inc. All rights reserved

Resuscitation outcomes comparing year 2000 with year 2005 ALS guidelines in a pig model of cardiac arrest

Background: Ventricutar fibrillation remains the leading cause of death in western societies. International organizations publish guidelines to follow in case of cardiac arrest. The aim of the present study is to assess whether the newly published guidelines record similar resuscitation success with the 2000 Advanced Life Support Guidelines on Resuscitation in a swine mode( of cardiac arrest. Methods and results: Nineteen landrace/large white pigs were used. Ventricular fibrillation was induced with the use of a transvenous pacing wire inserted into the right ventricle. The animals were randomized into two groups. In Group A, 10 animals were resuscitated using the 2000 guidelines, whereas in Group B, 9 animals were resuscitated using the 2005 guidelines. Both algorithms recorded similar successful resuscitation rates, as 60% of the animals in Group A and 44.5% in Group B were successfulty resuscitated. However, animals in Group A restored a rhythm, compatible with a pulse, quicker than those in Group B (p = 0.002). Coronary perfusion pressure (CPP) was not adversely affected by three defibrillation attempts in Group A. Conclusions: Both algorithms’ resulted in comparable resuscitation success, however, guidelines 2000 resulted in faster resuscitation times. These preliminary results merit further investigation. (c) 2006 Elsevier Ireland Ltd. All rights reserved

EVALUATION OF GREEK HIGH SCHOOL TEACHERS' KNOWLEDGE IN BASIC LIFE SUPPORT, AUTOMATED EXTERNAL DEFIBRILLATION, AND FOREIGN BODY AIRWAY OBSTRUCTION: IMPLICATIONS FOR NURSING INTERVENTIONS

Introduction: The aim of this study was to evaluate the theoretic knowledge of high school teachers regarding cardiopulmonary resuscitation, automated external defibrillation, and foreign body airway obstruction. Methods: Three hundred ten respondents were tested prospectively by use of a scoring system. Data were obtained by use of a questionnaire that included 24 questions. Data were collected between April 9 and June 16, 2009. Results: Only 21.03% of the teachers had ever participated in life support courses, and most of them did not possess adequate theoretic knowledge in the management of adult cardiac arrest or foreign body airway obstruction. As the age of the teachers increases, the ratio of correct answers decreases. Life support course attendance has a positive effect on their theoretic knowledge. The majority of the teachers would welcome an emergency nurse to educate them and their students on basic life support and foreign body airway obstruction. Discussion: This study shows that most of the respondents had a mediocre level of knowledge in basic life support, automated external defibrillation, and foreign body airway obstruction. Given that emergency nurses regularly practice resuscitation in the emergency department in which they are working, they have the motivation to be kept updated with the current guidelines on resuscitation, because guidelines on resuscitation are revised every 5 years. Teachers, on the other hand, are less motivated to be kept updated; thus emergency nurses may be the key component in educating teachers and school students. Therefore we believe that emergency nurses should take on the responsibility and act as school educators regarding cardiopulmonary resuscitation