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Treating the dead

Discussion in 'Emergency Medicine' started by skowly, May 2, 2007.

  1. skowly

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    Apologies if someone's already done this, but:

    http://www.msnbc.msn.com/id/18368186


    Anyone keeping up with this? 80% v. 15% save-rate seems pretty eye-popping, but I can't help but think that n is pretty small. Anyone read any journal articles about this? Any been published?


    "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.

    But if the cells are still alive, why can't doctors revive someone who has been dead for an hour? Because once the cells have been without oxygen for more than five minutes, they die when their oxygen supply is resumed. It was that "astounding" discovery, Becker says, that led him to his post as the director of Penn's Center for Resuscitation Science, a newly created research institute operating on one of medicine's newest frontiers: treating the dead."
     
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  3. IntheDraft6

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    Here is a link to the original article mentioned in the story. It seems like it might be good for in-hospital arrests in hospitals with a CT surgeon and cath lab, but otherwise does not look too promising (I do have to admit that I did not get to read it fully, just kind of skimmed through it so I could be incorrect).

    http://repositories.cdlib.org/cgi/viewcontent.cgi?article=5092&context=postprints
     
  4. nachoDoc

    nachoDoc On the beach
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    Wow.. controlled reperfusion...hypothemia...minimal neuro comp...hmmmm results seem interesting and well worth following up on further work.

    *gets that queezy feeling that if this proves to be a significant factor in survivability...oh man! If only I knew then....*
     
  5. GeneralVeers

    GeneralVeers Globus Hystericus
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    The secret is electricity, to "re-animate" the dead tissues. All we need is a brain.
     
  6. racerx

    racerx ASA Member

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    #
     

    Attached Files:

  7. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    One of his better movies.
     
  8. Wackie

    Wackie Inappropriate, always

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    I was going to ask how quickly you can reroute blood to perfuse everything but the heart, but thought it might be a stupid premed question.


    Edit: It's Fraunkinshteen!
     
  9. southerndoc

    southerndoc life is good
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    Interesting concept. Today's weird and rejected treatments are tomorrow's standards of care. In ten years, EMS may be transporting cardiac arrest patients to facilities capable of cardiac bypass.
     
  10. Jeff698

    Jeff698 EM/EMS nerd

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    Treating the dead is a new concept?

    Hell, I'm on that rotation right now.

    PICU.

    Sad but true.

    I'm going to drown my sorrows in some light reading about PID. That'll help.

    Take care,
    Jeff
     
  11. paramed2premed

    paramed2premed Senior Member

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    And we thought amiodarone for VF was expensive . . .:eek:
     
  12. southerndoc

    southerndoc life is good
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    At least this seems to improve outcome to discharge. (In defense of Copass and Kudenchuk, their study was never powered nor intended to evaluate to hospital discharge.)
     
  13. Jarabacoa

    Jarabacoa non carborundum ilegitemi

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  14. Jarabacoa

    Jarabacoa non carborundum ilegitemi

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    What good is a functional body (supposing that the heart, lungs, kidneys, pancreas, etc. bounce back) without a functioning brain? It kills me every time we do CPR on some 80 year old person with horrible co-morbidities (aside from now being dead). When somebody that old comes in in asystole or PEA that has had minimal perfusion and minimal oxygenation, I'm always praying that their heart doesn't start beating again. Come on, what is the best case scenario here? Surviving to live in a nursing home the rest of their life on a ventilater because they're essentially brain dead? In a way, the sicker the patient, the less pressure there is to save them. I know i'm a heartless individual. And I warped? It seems that more and more, the public thinks of death as an option, not an eventuality. So, until they give me great evidence that the patient's brain is going to survive intact, with great quality of life. I'm not going to put people on cariopulmonary bipass. Pediatrics, or young, healthy adults? Different story. People die for physical reasons. If that physical reason is still going to be there when they wake up (clogged coronary arteries, Pulmonary embolus, cancer, overwhelming infection, brain injury, etc.), why waste millions of dollars to wake them up so that they can kick the bucket again in a few months or years? After I'm 60, DNR/DNI will be tattooed on my chest. It's like going bald, don't fight it, it doesn't make your life better, and you tend to get pre-occupied with the pursuit of hair. We should all die, and go bald gracefully.
     
  15. Janders

    Janders Senior Member

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    I agree that prolonged CPR with poor neurological outcome is sad, and that a lot of codes have no happy ending, regardless on if the heart restarts. However, if you check out the full article posted above they actually got suprisingly good neuro outcomes, along with the restarted hearts.

    They state that, in general, "a third of patients who are
    resuscitated have evidence of significant neurological dysfunction," and, more specifically, "if coma follows successful cardiac resuscitation, 73% of patients are significantly impaired neurologically."

    In their series, the:

    "neurological complications were rare. One patient had seizures for two days possibly related to lidocaine required for control of dysrhythmias. There were two permanent adverse neurological outcomes (5.8%). As described above, one patient with a history of stroke and severe peripheral vascular disease recovered cardiac function but suffered a massive stroke postoperatively and died. Another patient became paraplegic postoperatively. This patient presented by helicopter following infarction in shock. CPR was sustained for one hour during transport during unsuccessful attempts to cardiovert ventricular fibrillation. Femoral bypass was established in the catheterization laboratory while coronary pathology was defined. Three coronary grafts were constructed and an IABP placed in the ascending aorta due to severe peripheral vascular disease. The patient recovered full cardiac function but suffered from spinal cord ischemia and has remained hemiplegic in the lower extremities five years later.

    The remaining patients had grossly normal neurological function and ambulated normally at the time of hospital discharge."


    (Sorry for the large quotes)

    So, all and all, a small experimental cohort, but some exciting results.
     
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  17. 042686

    042686 New Member

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    Impressive!
     
  18. paramed2premed

    paramed2premed Senior Member

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    I seem to recall a similar case series, published a few years ago, that treated victims of cardiac arrest with tPA, A subsequent prospective trial wasn'r as rosy in its findings, however. I'll see if I can get some references.
     

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