Læknablaðið : fylgirit - 15.06.2002, Qupperneq 12

ABSTRACTS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
O 09 - Cardiovascular Emergencies
Biphasíc versus monophasic wave shock for atrial fibrillation
and flutter cardioversíon: a randomized, prospective trial
Ruggiano G
Emerg. Dept., S. Maria Annunziata Hospital. Florence. Italy
Introduction: Clinical trials have recently shown that ventricular
fíbrillation resolution is more effective and requires lower energy
intensity using biphasic wave shock (BI-w S) instead of the tradi-
tional monophasic wave shock (Mono-w S).
Object: To verify whether a biphasic wave form shock is more
effective and needs lower energy intensity than a monophasic wave
form shock even in atrial fibrillation (AF) and atrial flutter (AFI)
transthoracic electrical cardioversion (TEC).
Methods: During five months 118 consecutive patients were rando-
mized (68 males, 50 females, 96 with atrial fibrillation and 22 with
atrial flutter) in two groups: the first group of patients (49 AF and
9 AFI) underwent Bi-w S TEC, the second group (47 AF and 13
AFl) was treated with Mono-w S TEC. All the patients had a clear-
cut indication for electrical cardioversion. The twp groups were
similar for all the clinical parameters but the duration of the dys-
rhythmia was longer for the biphasic wave shock group. In both
groups we used progressively increasing energy intensities (50-75-
100-150-200 J for AF, 30-50-75-100-150-200 J for AFl with Bi-w S;
100-200-300-360 J for AF, 50-100-150-200-3600-360 J for AFI with
Mono-w S). Bi-w S was given using a Zoll M-biphasic electrical
defibrillator, which utilizes a rectilinear biphasic wave, while we
used the traditional Zoll and HP electrical defibrillator for the
Mono-w S. We used the disposable auto-adhesive plates in the
antero-posterior position for all the patients.
Results: Sinus rhythm was obtained in 48/49 patients with AF
(97,9%) and in 9/9 patients with AfF (100%) in the BI-w S group
and in 43/47 patients with AF (91,4%) and 13/13 patients with AFL
(100%) in the Mono-w S group. In AF patients, the first shock was
effective in 61,2% of the BI-w S (50 J) treated group, and in 42,5%
of the Mono-w S (100 J) group; the effective energy intensity level
was lower for the BI-w S group. In AFl patients the first shock was
effective in 88,9% of cases with Bi-w S (30 J) and in 53% of cases
with Mono-w S (50 J).
Condusions: Our data show that in AF electrical cardioversion
with BI-w S is more effective than Mono-w S; the higher efficacy is
evident even at the first shock and is obtained with lower energy
intensity; this is true also in AFI. In all the treated patients the Bi-w
S TEC was a safe and complication-free procedure.
O 10 - Cardiovascular Emergencies
Attitude of the lcelandic population towards performing
cardiopulmonary resuscitation on strangers in the prehospital
setting
Arnar DO, Gizurarson S, Baldursson J
Landspitali University Hospital, Reykjavik, Iceland
Int roduction: Initiation of bystander cardiopulmonary resuscitation
(CPR) is directly linked to the outcome of cardiac arrest in the
community. Recent reports have indicated a reluctance among
witnesses to perform CPR on strangers, especially mouth to mouth
ventilation.
Methods: We conducted a telephone survey on 1200 randomly
selected Icelanders, aged 16-75, years with regard to their attitude
towards prehospital CPR on strangers. A total of 804 chose to
participate (70.1%).
Results: A large number (73%) had received some kind of training
in CPR, while only 6% had actually participated in a CPR attempt.
In accordance, 50% thought they would be able to perform chest
compressions adequately and 55% perform mouth to mouth venti-
lation to satisfactory standards. A total of 491 (65%) would likely
volunteer to perform chest compressions on a stranger, while 178
(24%) would not and 84 (ll%)were undecided. Similarly, 473
(63%) would likely volunteer to perform mouth to mouth ventila-
tion on a stranger, 177 (24%!) would not and 93 (13%) were unsure.
A significant majority, 620 (82%) said it would not make any diffe-
rence regarding their participation in bystander CPR if the proce-
dure was simplified and included only chest compressions.
Condusion: Icelanders have a very positive attitude towards by-
stander CPR, over 2/3 have had some kind of CPR instruction and
a large majority has no aversion towards performing mouth to
mouth ventilation on strangers. These results are in contrast to
similar data from other countries which show reluctance towards
bystander CPR especially the mouth to mouth ventilation compo-
nent. The lack of actual CPR experience by the participants in this
survey likely iníluences the outcome.
011- Neurologic Emergencies
Coma in the Emergency Department: past and present
Huff JS
Dept. of Emergency Medicine, Univ. of Virginia Health System, Charlottesville,
VA, United States
Objective: To define the contemporary adult population with acute
coma presenting to a university medical center and compare with
past studies of patients with coma in emergency departments.
Methods: Adults unresponsive at time of presentation to the
emergency department (ED) or at the time of emergency medical
services (EMS) scene arrival were identified through a three-stage
retrospective review process over the four-month study period by
one investigator using log-book, admitting service and diagnostic
listings, and physical chart review. Coma was defined as an eyes-
closed unresponsive state without purposeful speech or movement.
In case of any discrepancy in the depiction of the mental state at
time of arrival, the preponderance of descriptions was used to
define an unresponsive state. Patients with a chronic unresponsive
state were excluded. The setting was an academic center with a
large rural catchment area with annual ED census of 60,000. Com-
parisons were made to the only other studies of comatose patients
in the emergency department (Holcomb 1921; Solomon, Aring
1934).
Results: In the modern study population, 116 patients with coma
were identified during the study period. 27 patients (24%) became
responsive during emergency care; most were hypoglycemic and
responded to infusion of dextrose. 21 patients were dead at arrival
or shortly after arrival. The remaining 68 patients with persistent
unresponsiveness were comprised of multiple trauma patients
(11/68;16%), isolated cranial trauma (6/68;9%), post-cardiac arrest
(9/68;13%), nontraumatic intracranial masses (14/68;21%), neuro-
12 Læknablaðið/Fylgirit 45 2002/88