Review article
Recent Advances in Emergency Life Support

https://doi.org/10.1016/S0029-6465(03)00078-1Get rights and content

Section snippets

Overview

Adult cardiopulmonary resuscitation combines the treatment of cardiac arrhythmias with hypoxemia and neuroendocrine derangement. Despite a variety of advances in cardiopulmonary resuscitation (CPR) technique, public education, and emergency cardiac care, sudden cardiac death in the field from life-threatening arrhythmias affects approximately 125,000 individuals in the United States each year. The primary electric conduction disturbance seen in the prehospital cardiac arrest patient is

Defibrillation

In adults, the most common primary arrhythmia at the onset of cardiac arrest is ventricular fibrillation or pulseless ventricular tachycardia. The only intervention shown to improve long-term survival unequivocally is basic life support with defibrillation. New guidelines from the American Heart Association routinely employ automated external defibrillators with basic life support.2 Many of these devices include biphasic defibrillation waveforms. Research to date suggests that biphasic

New Airway Access: The Intubating Laryngeal Mask Airway

Although oral tracheal intubation remains the standard for definitive airway management, emergency management of the patient with atypical anatomy or head and neck injury continues to be problematic. One approach to this problem, the laryngeal mask airway (LMA), was proposed by Brain in the early 1980s. A recent addition to this technique, the intubating laryngeal mask airway (ILMA), was proposed by Brain and co-workers in 1995.4 The ILMA incorporates the standard LMA cuff in sizes three, four,

Vascular Access: The Sternal Intraosseous Needle

Emergency medical personnel routinely encounter patients needing emergent initiation of intravenous access because of blood loss from internal or external sources, cardiac arrest, dehydration, hypotension, and other medical or traumatic emergencies. The standard of care for these individuals includes placement of intravenous lines for administration of fluids and provision of medications. Where peripheral intravenous access is unavailable, an option is placing a central venous catheter.

Vasopressors

In animal studies, epinephrine improves myocardial and cerebral blood flow and resuscitation rates, and higher doses may be more effective than the standard dose of 1 mg. No clinical evidence suggests that epinephrine improves survival or neurologic recovery in human beings, however, regardless of whether standard or high doses are used. In fact, recent clinical trials report increased rates of spontaneous circulation with a high dose of epinephrine but no improvement in overall survival.

Summary

Recent advances in emergency life support include not only new drugs such as vasopressors and antiarrhythmic agents but new devices as well. These devices include biphasic defibrillators, the ILMA, and the sternal intraosseous needle. As research continues, the medications and methods used to deliver advanced life support are likely to expand; hopefully, in the years to come, they can improve patient outcomes and contribute to the quality of life after resuscitation.

First page preview

First page preview
Click to open first page preview

References (23)

  • American Heart Association

    Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care

    Circulation

    (2000)
  • Cited by (2)

    View full text