Interventions in the therapy of electromechanical dissociation.
Electromechanical dissociation (EMD) is a major arrest rhythm for which there is often inadequate treatment. The purpose of this study was to evaluate the different pharmacological and non-pharmacological interventions considered in the treatment of EMD. During the 6-year period, January 1st, 1980 to December 31st, 1985, 503 evaluable adult patients presented in a non-traumatic, non-poisoning cardiopulmonary arrest with the initial rhythm of EMD. One hundred nineteen patients obtained a pulse during resuscitation efforts following drug administration. The average time to obtaining pulses after the last drug administration was 1.97 +/- 2.21 min. The following drugs were last administered prior to transient pulses: bicarbonate, 31/119 (26%); epinephrine, 26/119 (22%); atropine, 26/119 (22%); dopamine, 13/119 (11%); calcium, 11/119 (9%); isoproterenol, 7/119 (6%); other drugs, 5/119 (4%). Ninety-five percent of the successful resuscitations received eight or less drug interventions and all saves received three or less drug interventions. Two hundred twenty-four patients (44.5%) had 288 non-pharmacological interventions. Twenty-three patients developed a pulse after intervention in the following distribution: MAST suit (N = 9), pericardiocentesis (N = 6), fluid challenge (N = 5), needle thoracostomy (N = 1), and intervention combinations (N = 2). The time interval between intervention and the onset of pulse was as follows: MAST suit, 4 +/- 2.8 min; pericardiocentesis, 3.7 +/- 3.6 min; fluid challenge, 4.8 +/- 4.1 min; needle thoracostomy, 6 min. The overall save rate for intervention patients was 0.9% whereas for those not having intervention it was 7.2% (P less than or equal to 0.0003).(ABSTRACT TRUNCATED AT 250 WORDS)
Vanags
B
B
Section of Trauma and Emergency Medicine, Medical College of Wisconsin, Milwaukee 53226.
Thakur
R K
RK
Stueven
H A
HA
Aufderheide
T
T
Tresch
D D
DD
D001285:Atropine / Q000627:therapeutic use; D001639:Bicarbonates / Q000627:therapeutic use; D004837:Epinephrine / Q000627:therapeutic use; D005676:Gravity Suits; D006323:Heart Arrest / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D009339:Needles; D011674:Pulse / Q000187:drug effects; D012151:Resuscitation; D013907:Thoracostomy / Q000379:methods
D001639:Bicarbonates; D001285:Atropine; D004837:Epinephrine