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iBSc Resus Science Symposium > Utstein > Flashcards

Utstein Flashcards

(60 cards)

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1
Q

What can cause inconsistency and variation between results of different resuscitation trials

A

Variation in study design, chest compression and ventilation quality, time intervals, experimental methods, animal models

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2
Q

What is the ‘tower of babel’ in cardiac arrest studies

A

Lack of standardisation and use of non uniform terminology

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3
Q

4 fundamental variables in animal resus research

A

Ventilation
Nonintervention interval(duration of untreated ca)
Measurement and production of bloodflow during compressions
Definition of ROSC

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4
Q

Baseline conditions

A

Physiological conditions attained before induction of CA - usually in an anaesthetised, intubated, ventilated, and instrumented animal

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5
Q

What aspects of baseline conditions should be described

A

How conditions achieved
Duration of conditions before beginning experiment

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6
Q

Disadvantages of baseline conditions

A

Do not represent normal physiological state of an animal

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7
Q

Which models of cardiac arrest allow easy determination of time of arrest

A

VF - time of induction easily determined
Asphyxia and exanguination - less precise, produce gradual change in haemodynamics over several minutes

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8
Q

What aspects of CA induction should be recorded

A

Method and time of induction graphically on a timeline
For exanguination/asphyxiation - description of induction period from baseline to preselected critical value of BP, HR, H rhythm, or ECG
Technique to induce arrest should be defined precisely enough to be reproducible

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9
Q

Clinical CA definition

A

Cessation of cardiac mechanical activity
Unresponsiveness, absent detectable pulse, apnea/agonal resps

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10
Q

Methods of identifying arrest in laboratory

A

ECG
Loss of arterial pulsation
Systolic aortic BP <25mmHg

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11
Q

Standard CPR in clinical studies

A

External chest compressions and ventilation quality

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12
Q

Standard chest compression

A

External closed chest compressions applied to an area of the chest approx the size of a heel of an adults hand
Freq 60-100/min
50% duty cycle
Downward compression force sufficient to produce 3.8-5cm chest displacement (may vary by species/size)

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13
Q

Standard ventilation

A

Doesn’t exist for lab models of CPR
Baseline and experimental ventilation parameters should be described in detail

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14
Q

Ventilation

A

Any movement of gas in and out of the lungs
Does not necessarily result in alveolar gas exchange esp if tidal vol<dead space vol

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15
Q

Types of ventilation

A

Spontaneous gasping
Agonal respirations
Mechanical ventilation
Gas movement resulting from chest compressions

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16
Q

Why should a volume cycled ventilator be used to measure PPV rather than pressure cycled ventilators

A

Pressure cycled may deliver inconsistent tidal volumes during CPR due to changes in pulmonary compliance

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17
Q

Alveolar ventilation

A

Amount of inspired gas available for gas exchange
Minute ventilation - dead space ventilation

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18
Q

Which ventilation parameters should be recorded

A

2/3 of
- minute ventilation
- tidal volume
- resp rate

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19
Q

Phases of BP measurements during the CPR cycle

A

Compression phase - BP measurements obtained when applied force decreases thoracic volume (analogous to systolic)
Release phase - bp measurements when little/no pressure applied to thorax allowing recoil (analogous to diastolic)

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20
Q

Active decompression

A

When an outward force is applied to the external chest during release phase
Requires a decompressive adjunct

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21
Q

What measurement if used as a surrogate for direct measurement of coronary bloodflow in studies

A

Coronary perfusion pressure

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22
Q

Blood flow

A

Volume of blood flowing in a given direction per unit of time

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23
Q

Region specific bloodflow

A

Blood flow per unit mass of tissue

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24
Q

Defibrillation attempt / rescue shock

A

Electrical shock used a specifically to defibrillate an experimentally indices episode of VF

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25
Aspects of defibrillation attempts that should be recorded
Number Timing Strength of shock
26
Principal means of assessing circulation in lab CPR
Arterial pressure During CA - nonpulsatile art pressure of 10-20mmHg due to vascular tone
27
Return of spontaneous cardiac contractile activity
Return of pulsations in the arterial pressure waveform
28
Aspects of ROSC that must be prospectively defined
Minimum aortic BP for a specified minimum time If vasoactive drugs were administered during this time and if drugs were allowed to wash out
29
Recommended ROSC definition
Maintainance of Systolic aortic BP 60+ for 10+ consecutive minutes
30
Survival
Existence beyond ROSC and immediate post arrest period Should extend at least 24 hours
31
Interval
Period of time between 2 events
32
Time point
One point in time
33
Nonintervention interval
Interval of untreated CA without chest compression
34
Why should ‘downtime’ not be used
Imprecise No agreed definition No precise non intervention interval
35
What should be included in an experimental timeline
Critical times, events, and intervals Induction of CA Nonintervention interval Treatment interval Duration of outcome
36
Optimal method for testing hypothesis
Prospective study with concurrent control group
37
Benefits of concurrent control groups
Blind investigators to some interventions Control bias in animal selection Control experimental variation
38
What factors can cause physiological alterations in rodents
Disturbances in circadian rhythm Environmental changes Temperature Humidity Airflow parameters Viruses and pathogens
39
Conditioned
An animal is free of clinical disease and has been vaccinated and treated for parasites
40
Specific-pathogen-free
Swine from a herd accredited by a national agency
41
Purpose bred
Dog bred specifically for research in a regulated facility
42
Anatomical and physiological characteristics that should be considered when selecting animals for studies
Species Different responses to drugs Different drug doses needed in different species for the same result Interpretation of CPR/pharma interventions Metabolism Physiological function Ischaemia response Hypoxia response Hypercarbia response Difficulty achieving ROSC in mammals Myocardial blood supply Sensitivity to arrythmia Differences in compliance and shape of chest
43
Why might rodents and young animals be more resistant to hypoxia and hypercarbia
Metabolic differences
44
Ethical considerations for animal experimentation
Approval of protocol by animal use comittee Use of adequate analgesia Study design that minimises number of animals used
45
Advantages of rats
Screening and confirmatory tests needing large number of animals Neurological models Studies incorporating behavioural techniques
46
Disadvantages of rats
Less clinically relevant than pigs or dogs Spontaneously self defib - not used in studies needing electrically induced VF Differences in inbred and outbred rat stocks
47
Adbvantages of dogs
Extensive data available of dog models Similar CVS function to humans
48
Disadvantages of dogs
Extensive collateral circulation in the heart and differences in myocardial bloodflow to humans Differences to humans in chest, heart, and brain size and shape Pre-existing conditions - heart worms, chronic myocarditis secondary to parvovirus
49
Advantages of pigs
Information on swine models more current than dog models Uniform size and shape between breeds at similar age and weight Many similarities in metabolic and cvs function with humans Similar cononary anatomy to humans
50
Disadvantages of pigs
Left azygous vein enters coronary sinus rather than precava Less background info on ping models than dog models Susceptibility to malignant hyperthermia
51
What aspects of animal preparation should be recorded
Perioperative conditions Anaesthesia
52
Baseline measurements in CPR research
Pulse rate Cardiac output Coronary perfusion pressure Bp - mean and cyclical arterial, central venous, right atrial pressure Vascular resistance End tidal co2 Arterial and central VBG Electrolyte levels Core temp
53
What marks the beginning and end of the experimental period
Begin - induction of CA or admin of experimental intervention End - assessment of final outcome variables Time interval between = duration of experiment protocol
54
What elements should be considered when designing protocols for a CA resus study
Nonintervention interval CPR duration Attempted defibrillation Use of drugs and other interventions Post resus care Ventilation - O2 conc, airway control, spontaneous/controlled Induction of CA
55
Potential problem of short nonintervention interval
May not show effect of a treatment that might be significant with a longer interval
56
Why can pulse oximetry not be used during CA
Pulsatile bloodflow through a tissue bed is needed for accurate estimation of Hb O2 saturation
57
Advantages of VBG over ABG
More closely reflects tissue oxygenation and acid base conditions
58
How can cardiac output be cal;curated based on arteriovenous differences
Fick technique
59
How long does it take for cerebral dysfunction and morphological changes to stabilise after CA and reperfusion
3 days
60
Measurement of cerebral outcome
Morphology - histopathological damage score Function - overall performance, neurological damage scores EEG patterns in early post arrest animals are consistent but dont correlate well with functional and morphological outcome scores

iBSc Resus Science Symposium (7 decks)

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