exudates and Heart-Arrest

Cardiopulmonary resuscitation (CPR) has been standard treatment for all cardiac arrest patients that arrive at the Emergency Department. However it is unclear whether prolonging resuscitation among the elderly victims will provide any benefit or improve outcome. This study is to evaluate factors that can influence outcome of CPR among the elderly, such as time of arrest, duration of CPR, lactate levels and age (among elderly age groups). 89 patients fit the inclusion criteria from January 2007 to January 2009, and all underwent CPR. Lactate levels (p=0.047) and duration of CPR performed (p=0.019) had significant relation to outcome. Time of arrest to CPR and age had no significance. Of 89 patients studied, 4 (4.5%) survived to hospital discharge. The remaining 85 (95.5%) died either in the emergency department, the wards or the Intensive Care Unit. Among the survivors, only 2 (2.3%) functional (independent on activities of daily life) patients were identified. Among the survivors, the mean lactate level was 4.0 mmol/L. The mean lactate levels among the dead were 9.84 mmol/L. The mean length of CPR among the survivors was 5.42 minutes and for the non-survivors, 19.28 minutes. This study reports certain factors such as duration of resuscitation and initial lactate levels that can be valuable tools in decision making when resuscitating an elderly.

Topics: Age Factors; Aged; Cardiopulmonary Resuscitation; Female; Heart Arrest; Humans; Lactic Acid; Malaysia; Male; Retrospective Studies; Time Factors; Treatment Outcome

Junior doctors are often the "first line" doctors called to attend to patients in cardiac arrest. We performed an anonymous questionnaire study from October 2008 to December 2008 to assess the knowledge, attitude and skill of cardiopulmonary resuscitation among junior doctors in Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab II. Out of the 100 questionnaire forms sent out, 70 were returned completed. The majority (85.8%) stated that they were not confident of managing a resuscitation case. There was a statistically significant (p<0.001) association between duration of clinical practice and confidence level. Up to 77.1% said that BLS should be re-certified every two years.

Topics: Adult; Animals; Cardiopulmonary Resuscitation; Heart Arrest; Humans; Malaysia; Skates, Fish; Surveys and Questionnaires

This voluntary, anonymous questionnaire survey was performed to assess the willingness of Basic Life Support (BLS) participants to perform bystander cardiopulmonary resuscitation (CPR). A total of 55 dental students and 73 school teachers were assessed on their willingness to perform bystander CPR after completion of their BLS training. In general, only 29.0% of the total 128 participants said that they would offer to perform CPR under any cardiac arrest condition and 69.0% said that they would just offer to call the ambulance but they would not offer to perform CPR. When analyzed separately, only 16.4% of school teachers said that they would perform CPR as compared to 45.5% of dental students (p < 0.001). Knowing how to perform CPR does not necessarily translate into willingness to perform CPR.

Topics: Adult; Attitude; Cardiopulmonary Resuscitation; Chi-Square Distribution; Female; Heart Arrest; Helping Behavior; Humans; Malaysia; Male; Students, Dental

Bystander cardiopulmonary resuscitation (CPR) serves as a vital link to improve the chance of survival among the out-of-hospital cardiac arrest (OHA) patients. The frequency of bystander CPR in Malaysia is largely unknown. The aim of this study was to find out how frequently bystander CPR was performed among OHA patients with CPR performed at the Emergency Department (ED), Hospital Universiti Sains Malaysia (HUSM), prior to their arrival to the department.. In this one-year observational study, data was collected from cases of CPR performed in ED, HUSM. In the OHA category, a subanalysis was further performed to look into the frequency and effects of bystander CPR on achieving return of spontaneous circulation and survival to hospital admission. The categorical data collected was analysed using chi-square test or Fisher-exact test.. Out of a total of 23 OHA patients that had CPR performed on arrival at the ED, HUSM, from March 2005 to March 2006, only two cases (8.7 percent) had bystander CPR performed. None of these two cases achieved return of spontaneous circulation.. Although this study has many limitations, it does indicate that the frequency of bystander CPR is dismally low in our community and the mere fact that bystander CPR was reported to be done does not seem to translate into a higher chance of survival to admission. The quality and effectiveness of the technique is equally important.

Topics: Cardiopulmonary Resuscitation; Electric Countershock; Emergency Medical Services; Emergency Treatment; First Aid; Health Education; Heart Arrest; Humans; Malaysia

Despite the progresses made in the science of cardiopulmonary resuscitation, there is lack of published works on this area in the Malaysian context. This survey was done to look at the outcomes of all cardiopulmonary resuscitation performed in Emergency Department (ED), Hospital Universiti Sains Malaysia (HUSM). This is a one year cross-sectional study from March 2005-March 2006. All adult cardiac arrest cases with CPR performed in ED, HUSM were included in the survey. The end points are return of spontaneous circulation (ROSC) and survival to ward admission. Out of the total 63 cases of cardiac arrest with CPR performed, only 19 cases (30.2%) had ROSC after CPR performed on them. Eventually only six patients (9.5%) had survival to ward admission. Patients with shockable intial arrest rhythm has a significantly higher chance to achieve ROSC (60.0%) compared to non-shockable rhythms (24.5%) (p = 0.025). However, there was no different in survival to ward admission between shockable and non shockable rhythms groups. The survival after cardiac arrest is still dismally poor. Perhaps we should be more selective in initiating CPR especially for out of hospital cardiac arrest.

Topics: Cardiopulmonary Resuscitation; Cross-Sectional Studies; Emergency Service, Hospital; Heart Arrest; Humans; Malaysia; Treatment Outcome

From April through June 1997, 29 previously healthy children aged <6 years (median, 1.5 years) in Sarawak, Malaysia, died of rapidly progressive cardiorespiratory failure during an outbreak of hand, foot, and mouth disease caused primarily by enterovirus 71 (EV71). The case children were hospitalized after a short illness (median duration, 2 days) that usually included fever (in 100% of case children), oral ulcers (66%), and extremity rashes (62%). The illness rapidly progressed to include seizures (28%), flaccid limb weakness (17%), or cardiopulmonary symptoms (of 24 children, 17 had chest radiographs showing pulmonary edema, and 24 had echocardiograms showing left ventricular dysfunction), resulting in cardiopulmonary arrest soon after hospitalization (median time, 9 h). Cardiac tissue from 10 patients showed normal myocardium, but central nervous system tissue from 5 patients showed inflammatory changes. Brain-stem specimens from 2 patients were available, and both specimens showed extensive neuronal degeneration, inflammation, and necrosis, suggesting that a central nervous system infection was responsible for the disease, with the cardiopulmonary dysfunction being neurogenic in origin. EV71 and possibly an adenovirus, other enteroviruses, or unknown cofactors are likely responsible for this rapidly fatal disease.

Topics: Antigens, Viral; Child, Preschool; Disease Outbreaks; Disease Progression; Exanthema; Fever; Hand, Foot and Mouth Disease; Heart Arrest; Humans; Immunohistochemistry; Infant; Malaysia; Male; Muscle Weakness; Neurons; Oral Ulcer; Seizures; Survival Rate; Tissue Distribution

Many of the costs associated with prehospital care in developed countries are covered in budgets for fire suppression, police services, and the like. Determining these costs is therefore difficult. The costs and benefits of developing a prehospital care system for Kuala Lumpur, Malaysia, which now has essentially no emergency medical services (EMS) system, were estimated. Prehospital therapies that have been suggested to decrease mortality were identified. A minimal prehospital system was designed to deliver these treatments in Kuala Lumpur. The potential benefit of these therapies was calculated by using statistics from the United States corrected for demographic differences between the United States and Malaysia. Costs were extrapolated from the current operating budget of the Malaysian Red Crescent Society. Primary dysrhythmias are responsible for almost all potentially survivable cardiac arrests. A system designed to deliver a defibrillator to 85% of arrests within 6 minutes would require an estimated 48 ambulances. Kuala Lumpur has approximately 120 prehospital arrhythmic deaths per year. A 6% resuscitation rate was chosen for the denominator, resulting in seven survivors. Half of these would be expected to have significant neurological damage. Ambulances cost $53,000 (US dollars) to operate per year in Kuala Lumpur; 48 ambulances would cost a total of $2.5 million. Demographic factors and traffic problems would significantly increase the cost per patient. Other therapies, including medications, airway management, and trauma care, were discounted because both their additional cost and their benefit are small. Transport of patients (including trauma) is now performed by police or private vehicle and would probably take longer by ambulance. A prehospital system for Kuala Lumpur would cost approximately $2.5 million per year. It might save seven lives, three of which would be marred by significant neurological injury. Developing countries would do well to consider alternatives to a North American EMS model.

Topics: Arrhythmias, Cardiac; Cost Savings; Cost-Benefit Analysis; Developing Countries; Emergency Medical Services; Health Care Costs; Health Planning; Heart Arrest; Humans; Malaysia; Models, Organizational; North America; Program Development; Survival Analysis; Urban Health

Topics: Acidosis; Adult; Anesthesia, General; Appendectomy; Blood Pressure; Cryosurgery; Electrocardiography; Fever; Heart Arrest; Humans; Malaysia; Male; Medicine, Traditional; Pulse; Religion and Medicine; Respiration, Artificial; Shock, Septic; Succinylcholine