Laerdal Foundation

BackgroundRecent advances in treatment for stroke give new possibilities for optimizingoutcomes. To deliver these prehospital care needs to become moreefficient.AimTo develop a framework to support improved delivery of prehospital care. Therecommendations are aimed at clinicians involved in prehospital andemergency health systems who will often not be stroke specialists but needclear guidance as to how to develop and deliver safe and effective care foracute stroke patients.MethodsBuilding on the successful implementation program from the GlobalResuscitation Alliance and the Resuscitation Academy, the Utsteinmethodology was used to define a generic chain of survival for EmergencyStroke Care by assembling international expertise in Stroke and EmergencyMedical Services (EMS). Ten programs were identified for Acute Stroke Careto improve survival and outcomes, with recommendations for implementation ofbest practice.ConclusionsEfficient prehospital systems for acute stroke will be improved throughpublic awareness, optimized prehospital triage and timely diagnostics, andquick and equitable access to acute treatments. Documentation, use ofmetrics and transparency will help to build a culture of excellence andaccountability.

Fink, Ericka L. MD; Callaway, Clifton W. MD, PhD; Tisherman, Samuel A. MD; Kochanek, Patrick M. MD, FCCM Author Information

A review of the literature on comparative fishing trials for deep water species using both trawl and longline is presented. Most attention is given to length and species selectivity. Other issues discussed are fish behaviour, energy consumption and quality of the products.

The effect of angiotensin II on myocardial blood flow and acid-base status during cardiopulmonary resuscitation (CPR) was assessed. Fourteen pigs were allocated randomly to receive either 0.9% saline (n = 7) or 0.05 mg/kg angiotensin II (n = 7) after 4 min of ventricular fibrillation and 3 min of open-chest CPR. Total myocardial blood flow (measured with radiolabeled microspheres) before, 90 s, and 5 min following drug administration was 74 +/- 18, 62 +/- 12, and 54 +/- 11 mL.min-1 x 100g-1 (mean +/- SD) in the control, and 72 +/- 17, 125 +/- 25, and 74 +/- 20 mL.min-1 x 100 g-1 in the angiotensin II group (P < 0.001 at 90 s and P < 0.05 at 5 min). The PCO2 of coronary venous blood at 90 s after drug administration was 82 +/- 8 mm Hg in the control group as compared to 47 +/- 9 mm Hg in the angiotensin II group (P < 0.001). Only three of the seven control group animals could be resuscitated successfully, whereas all of the angiotensin II-treated pigs survived the 1-h observation period (P < 0.05), during which neither arterial hypertension nor bradycardia was observed. Angiotensin II was associated with an improvement of myocardial blood flow during CPR and short-term resuscitation success. The increase in myocardial perfusion is associated with a lower coronary venous PCO2 and a higher coronary venous pH. The authors conclude that angiotensin II administration facilitated cardiopulmonary resuscitation.