Unsuccessful emergency medical resuscitation - are continued efforts in the emergency department justified?

Article Abstract:

Cardiopulmonary resuscitation was developed 30 years ago as a method of reviving patients who have suffered acute and reversible trauma. Over the years, it has become a popular practice to attempt resuscitation on severely ill patients who have little chance of survival. Studies have shown that resuscitation has limited benefit among elderly patients and patients with kidney failure, cancer, pneumonia, or sepsis (severe bacterial infection of the blood). Today, most hospitals in the US have established do-not-resuscitate policies for patients with a poor prognosis. Cardiopulmonary resuscitation can be provided by emergency medical services at the site of an accident or on route to the hospital. When resuscitation performed on the way to the hospital is not successful, continued efforts to revive the patient are made at the emergency room. A study was performed to determine if it is worth while to continue to try to resuscitate patients in emergency rooms when resuscitation performed on the way to the hospital has failed. Over a 19-month period, resuscitation was attempted in a hospital emergency room on 185 patients who did not respond to resuscitation on the way to the hospital. Resuscitation efforts were successful in reviving 16 patients (9 percent). These patients spent an average of 2.3 days in an intensive care unit and had a 12.6-day average length of hospitalization. Only one of the patients regained consciousness following resuscitation, and all of the patients died. The services the 16 patients received cost $180,908. It is concluded that, in most cases, it is not worth while to continue resuscitation efforts in the emergency room when prior attempts at resuscitation have failed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Usage, Evaluation, Hospitals, Hospital emergency services, Cardiac arrest, Resuscitation, Cardiac resuscitation

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A common clinical conundrum

Article Abstract:

The management of patients with atherosclerosis of both the coronary arteries and carotid arteries in the neck can present many challenges. Operations at either site have a 5% to 6% complication rate of stroke or death and the rate of such complications after combined surgery at both sites is 7% to 9%. Most surgeons prefer to combine the operations, although there is no evidence that such an approach is better. The development of cylindrical tubes called stents has lowered the risk of carotid artery surgery. This technique was successfully used on one man who then had a coronary artery bypass 3 days later.

Complications and side effects, Surgery, Coronary heart disease, Carotid artery diseases, Endarterectomy

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Heart or head?

Article Abstract:

A case is reported of a woman who had hypertension that was caused by atherosclerosis in her subclavian arteries. These arteries supply blood to the arms. She also had chest pain and had a history of surgery for arterial occlusive disease. She eventually received angioplasty and a stent to open the subclavian arteries and keep them open. When this was done, her blood pressure decreased and her chest pain no longer occurred.

Case studies, Hypertension, Causes of, Arterial occlusions, Arterial occlusive diseases

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