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Emesis in sudden cardiac arrest
Resuscitation (2007) 75, 389—390
LETTERS TO THE EDITOR Emesis in sudden cardiac arrest
Tom Silfvast Department of Anaesthesia and Intensive Care, Helsinki University Hospital, Helsinki, Finland
Sir, We read with great interest the article by Simons et al.1 on the incidence of emesis in sudden cardiac arrest. The authors found that the patients who received bystander CPR had emesis more frequently than those who did not receive bystander CPR. The results are consistent with our recently published data on the incidence and timing of gastric regurgitation during cardiopulmonary resuscitation in out-of-hospital setting2 and contribute more data to the current discussion about the mode of bystander CPR in cardiac arrest.3 Of special interest in this context is whether the victim receives bystander ventilation during CPR, which seems to affect the risk of regurgitation of gastric contents.2 It is unfortunate that Dr. Simons and colleagues did not report detailed data on the mode of bystander CPR (ventilation only, chest compression only or conventional CPR) in their interesting article. It would be of great value if the authors could explore their large database further and provide data whether there was an association between bystander ventilation and regurgitation during CPR.
References 1. Simons R, Rea T, Becker L, Eisenberg M. The incidence and significance of emesis associated with out-of-hospital cardiac arrest. Resuscitation 2007;74:427—31. 2. Virkkunen I, Kujala S, Ryyn¨ anen S, et al. Bystander mouth-tomouth ventilation and regurgitation during cardiopulmonary resuscitation. J Intern Med 2006;260:39—42. 3. SOS-KANTO Study Group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet 2007;369:920—6.
Ilkka Virkkunen ∗ Arvi Yli-Hankala Department of Surgery and Anaesthesiology, Tampere University Hospital,POB 2000, FIN-33521 Tampere, Finland
∗ Corresponding
author. Tel.: +358 3 311611; fax: +358 3 31164363. E-mail address: ilkka.virkkunen@uta.fi (I. Virkkunen) 7 May 2007
doi: 10.1016/j.resuscitation.2007.05.008
Glycaemic control and prediction of ICU stay Sir, The possible mortality benefit of tight glycaemic control with intensive insulin therapy in the critically ill has been examined in several studies in the intensive care unit (ICU).1,2 This work seems to suggest improved survival with tight glycaemic control but only in patients with an actual ICU length of stay of three days or over, results that continue to generate debate relating to safety and applicability.3 As a part of their inclusion process, these trials have required clinicians to predict patient length of stay around the time of ICU admission. Their results imply that such predictions might guide therapy. In addition, the ongoing TracMan study4 aims to examine the mortality benefit of early tracheostomy in patients expected to require ventilatory support for seven days or more. Again, clinicians are required to estimate the duration of a treatment to institute an intervention. We decided to test the predictive power of ICU consultants for these two questions. The ICU in Aberdeen Royal Infirmary is a 16-bedded general unit in the UK. Consultants responsible for the care of patients were asked during the first 24 h of patients’ admission to estimate length of stay and duration of mechanical ventilation. We dichotomised these outcomes to less than three days or three days or more for ICU stay and to less than seven days or seven days or more for
0300-9572/$ — see front matter © 2007 Elsevier Ireland Ltd. All rights reserved.
LETTERS TO THE EDITOR Emesis in sudden cardiac arrest
Tom Silfvast Department of Anaesthesia and Intensive Care, Helsinki University Hospital, Helsinki, Finland
Sir, We read with great interest the article by Simons et al.1 on the incidence of emesis in sudden cardiac arrest. The authors found that the patients who received bystander CPR had emesis more frequently than those who did not receive bystander CPR. The results are consistent with our recently published data on the incidence and timing of gastric regurgitation during cardiopulmonary resuscitation in out-of-hospital setting2 and contribute more data to the current discussion about the mode of bystander CPR in cardiac arrest.3 Of special interest in this context is whether the victim receives bystander ventilation during CPR, which seems to affect the risk of regurgitation of gastric contents.2 It is unfortunate that Dr. Simons and colleagues did not report detailed data on the mode of bystander CPR (ventilation only, chest compression only or conventional CPR) in their interesting article. It would be of great value if the authors could explore their large database further and provide data whether there was an association between bystander ventilation and regurgitation during CPR.
References 1. Simons R, Rea T, Becker L, Eisenberg M. The incidence and significance of emesis associated with out-of-hospital cardiac arrest. Resuscitation 2007;74:427—31. 2. Virkkunen I, Kujala S, Ryyn¨ anen S, et al. Bystander mouth-tomouth ventilation and regurgitation during cardiopulmonary resuscitation. J Intern Med 2006;260:39—42. 3. SOS-KANTO Study Group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet 2007;369:920—6.
Ilkka Virkkunen ∗ Arvi Yli-Hankala Department of Surgery and Anaesthesiology, Tampere University Hospital,POB 2000, FIN-33521 Tampere, Finland
∗ Corresponding
author. Tel.: +358 3 311611; fax: +358 3 31164363. E-mail address: ilkka.virkkunen@uta.fi (I. Virkkunen) 7 May 2007
doi: 10.1016/j.resuscitation.2007.05.008
Glycaemic control and prediction of ICU stay Sir, The possible mortality benefit of tight glycaemic control with intensive insulin therapy in the critically ill has been examined in several studies in the intensive care unit (ICU).1,2 This work seems to suggest improved survival with tight glycaemic control but only in patients with an actual ICU length of stay of three days or over, results that continue to generate debate relating to safety and applicability.3 As a part of their inclusion process, these trials have required clinicians to predict patient length of stay around the time of ICU admission. Their results imply that such predictions might guide therapy. In addition, the ongoing TracMan study4 aims to examine the mortality benefit of early tracheostomy in patients expected to require ventilatory support for seven days or more. Again, clinicians are required to estimate the duration of a treatment to institute an intervention. We decided to test the predictive power of ICU consultants for these two questions. The ICU in Aberdeen Royal Infirmary is a 16-bedded general unit in the UK. Consultants responsible for the care of patients were asked during the first 24 h of patients’ admission to estimate length of stay and duration of mechanical ventilation. We dichotomised these outcomes to less than three days or three days or more for ICU stay and to less than seven days or seven days or more for
0300-9572/$ — see front matter © 2007 Elsevier Ireland Ltd. All rights reserved.