Raffay, Violetta

Objective Cardiac arrest is a daunting medical emergency. The aim of the present study was to assess whether the combination of adrenaline and glucagon would improve initial resuscitation success, 48-hour survival, and neurologic outcome compared with adrenaline alone in a porcine model of ventricular fibrillation. Methods Ventricular fibrillation was induced in 20 healthy Landrace/Large White piglets, which were subsequently left untreated for 8 minutes. The animals were randomized to receive adrenaline alone (n = 10, group C) and adrenaline plus glucagon (n = 10, group G). All animals were resuscitated according to the 2010 European Resuscitation Council guidelines. Hemodynamic variables were measured before arrest, during arrest and resuscitation, and during the first 60 minutes after return of spontaneous circulation. Survival and a neurologic alertness score were measured at 48 hours after return of spontaneous circulation. Results Return of spontaneous circulation was achieved in 8 animals (80%) from group C and 10 animals (100%) from group G (P =.198). A significant gradual increase in coronary perfusion pressure and diastolic aortic pressure over time, which started 1 minute after the onset of cardiopulmonary resuscitation, was observed. Three animals (30%) from group C and 9 animals (90%) from group G survived after 48 hours (P =.006), whereas neurologic examination was significantly better in the animals of group G (P <.001). Conclusions In this porcine model of prolonged ventricular fibrillation, the addition of glucagon to adrenaline improves hemodynamics during resuscitation and early postresuscitation period and may increase survival.

Human exposure to high altitude is increasing, through inhabitation of areas of high altitude, expansion of tourism into more remote areas, and air travel exposing passengers to typical altitudes equivalent to 8005 ft (2440 m). With ascent to high altitude, a number of acute and chronic physiological changes occur, influencing all systems of the human body. When considering that cardiac arrest is the second most common cause of death in the mountains and that up to 60% of the elderly have significant heart disease or other health problems, these changes are of particular importance as they may have a significant impact on resuscitation efforts. Current guidelines for resuscitation lack specific recommendations regarding treatment of cardiac arrest after ascent to high altitude or in aircraft. Therefore, we performed a comprehensive search in PubMed, CINAHL, Cochrane Library, and Scopus databases for studies relevant to resuscitation at high altitude. As no randomized trials evaluating the effects of physiological changes after ascent to high altitude on cardiopulmonary resuscitation were identified, our search was expanded to include all studies addressing important aspects on high altitude physiology which could have a potential impact on the resuscitation of cardiac arrest victims. The aim of this review is to discuss the major physiological changes occurring after ascent to high altitude and their potential effects on cardiopulmonary resuscitation. Based on the available data, specific suggestions are proposed regarding resuscitation at high altitude.