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De (on)zin van reanimeren

De (on)zin van reanimeren. Refereeravond SEH artsen Regio Amsterdam 18 juli 2013 Maartje Kruithof , SEH arts Vumc. Hoe de buitenwereld aankijkt tegen ‘reanimeren’. http://www.youtube.com/watch?feature=player_detailpage&v=jpMxpzfSRUA.

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De (on)zin van reanimeren

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  1. De (on)zin van reanimeren Refereeravond SEH artsen Regio Amsterdam 18 juli 2013 MaartjeKruithof, SEH arts Vumc

  2. Hoe de buitenwereld aankijkt tegen ‘reanimeren’ • http://www.youtube.com/watch?feature=player_detailpage&v=jpMxpzfSRUA

  3. Definitie van "Reanimatie"Regelmatig krijgt de Nederlandse Reanimatie Raad vragen over wat nu precies wordt bedoeld met het begrip Reanimatie. In mei 2009 heeft de Wetenschappelijke Raad zich gebogen over deze vraag en kwam daarbij na veel afwegingen tot de volgende definitie: "Reanimatie is het geheel van handelingen voor het herstel van spontane circulatie en/of ademhaling"

  4. De shockroom

  5. Wat te doen als SEH arts? • Zorgendat je kennis up-to-date is • Wat nog te verbeteren?

  6. Historie • Dood geaccepteerd als wil van God tot renaissance • Anekdotes: 1e “ooggetuigenverslag” geslaagde reanimatie 1237 v. Chr. : Koning Chyryba van Aleppogered van de verdrinkingsdood. • 1100 v Chrverslagvroedvrouw (dmvbeademen) • Hippocrates(460-377 v. Chr.) rietstengel • Asklepiades (128-56 v. Chr.) luchtpijpsnede. • Paracelsus (1493-1541) Attemptedthe resuscitation of a corpse using bellows (Arabic medical writings) • Andreas Vesalius (1514-1564) successfully using bellows to resuscitate asphyxiated dogs

  7. Societies for Saving “persons apparently drowned”  Amsterdam, Milan, Venice, Hamburg, Paris, St. Petersburg, Berlin, and Boston • Rond 1740s, verschillende casus mond-op-mondresuscitatie. • 1767 in Amsterdam de “Maatschappij tot behoudnis van den Drenkeling”richtlijnen:hoete handelen bij een schijnbaar overleden drenkeling. (ook mond-op-mond beademing en het duwen op de borstkas vermeld) • 1774 Cogan and Hawes: (Royal) Humane Society, London 'The Institute for Affording Immediate Relief for Persons Apparently Dead from Drowning'. the society would pay anyone who attempted the treatment for two hours —and pay twice as much if the patient survived. 

  8. Overige methoden • Drogen en opwarmen door wrijving over de huid • Houtenpijpenomlucht in de neus en longenteblazen en reukzout • Houtenblaasbalgomtabaksrook in ingewandenteblazen via de anus • Met mes in anus steken • Tot ~1811

  9. 1788 elektriseermachine • 1809 gesuggereerd om elektriciteit toe te passen op “newly dead people” • 1861 eerste succesvolle defibrillatie Prevost en Batelli • Electrische stroom en VF • 1947 Gurvich en Yuniev: discharge sent through chest of dog followed bij resumption of cardiac function • Belangrijke verbeteringen van defibrillator in 1933 (Kouwenhoven) en 1947 (Beck).

  10. Wetenschappelijk onderzoek • 1848: Eerstedooddoor algeheleaneshesie • 1856 Airway clearance (Marshall Hall)'Asphyxia, its rationale and its remedy‘ • advies chest-pressure-arm-lift

  11. J Physiol. 1895 Jul 18;18(3):230-76.

  12. 1906

  13. ‘Closed’ chest compressions • 1892 Maass (Goetingen): Eerste gedocumenteerde succesvolle gesloten hartmassage …helaas in vergetelheid geraakt………. Open chest CPR tot ~ 1950

  14. Experiences with cardiac arrest, FH Lahey and ER Ruzicka; Surgery, gynecology and obstetrics, 1950; 90/1, 108-18

  15. 1950 American Medical Association

  16. Safar

  17. Vrijwilligers !

  18. Groepstraining

  19. 1966 AMA • 1e ACLS richtlijn • The ABCs of resuscitation • Zonder adrenaline • 1974 Adrenaline in protocol ACLS

  20. 1963

  21. BMJ. 2003 Dec 20;327(7429):1459-61.Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials.Smith GC, Pell JP.Source: Department of Obstetrics and Gynaecology, Cambridge University, Cambridge OBJECTIVES: To determine whether parachutes are effective in preventing major trauma related to gravitational challenge. DESIGN: Systematic review of randomised controlled trials. CONCLUSIONS: As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials.

  22. CONCLUSION: • Patients receiving adrenaline during cardiac arrest had no statistically significant improvement in the primary outcome of survival to hospital discharge although there was a significantly improved likelihood of achieving ROSC

  23. Epinephrineforcardiac arrest. Callaway CW.CurrOpinCardiol. 2013 Jan;28(1):36-42 • The available clinical data confirm that epinephrine during CPR can increase short-term survival (return of pulses), but point towards either no benefit or even harm of this drug for long-term survival or functional recovery

  24. WR NRR conclusie

  25. Jammer, helaas • Cordarone • Lidocaine • NaBic • Atropine • Fibrinolyse • Heparine • Vasopressine • Magnesium • Calcium • Procainamide? 60-90 min Onv. Bw Reden van niet-beschikbaarheid Om economische reden is dit product per 01-01-2007 uit het assortiment gehaald. [1]

  26. Vlotte ontwikkeling • Botnaald • Interventies • Echografie • Therapeutische Hypothermie

  27. Toekomst • LUCAS: (Nog) geen verbeterde survival • Ononderbroken compressietijdensschok • Continue aorta druk (1967-2011) • Prognose:

  28. Samenvatting • Wetenschap via NRR • Richtlijnen volgen • Rol SEH arts • Up to date blijven

  29. ?

  30. Referenties • Experiences with cardiac arrest, FH Lahey and ER Ruzicka; Surgery, gynecology and obstetrics, 1950; 90/1, 108-18 • Kouwenhoven, W.B.; Jude, J.R.; and Knickerbocker, G.G.:  Closed-Chest Cardiac Massage , JAMA 1960 173:1064-1067 • Weale, F., The efficiency of cardiac massage. Lancet, 1962 • P.Safar, International Congress Series 1242 (2002) 215- 227 • RichtlijnenNederlandseReanimatieraad(https://www.reanimatieraad.nl/) • Enkelefragmentenuit de geschiedenis van de reanimatie, Wulterkens;10e Reanimatie Congres 2013 (https://www.reanimatieraad.nl/) • Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial, Ian G. Jacobsa et al; Resuscitation82 (2011) 1138– 1143 • Epinephrine in cardiacresuscitation, John W. Pearson, Joseph S. Redding; Experimental andlaboratoryreports 1962, Volume 66 Number 2 • Prehospital Epinephrine Use and SurvivalAmong Patients With Out-of-Hospital Cardiac Arrest, AkihitoHagihara et al; JAMA. 2012;307(11):1161-1168 • Reanimatie buiten het ziekenhuis in Noord-Holland en Twente: resultaten ARREST onderzoek over 2006-2011, S.G. Beesems*, J.A. Zijlstra*, R. Stieglis, R.W. Koster • THE PHYSIOLOGICAL EFFECTS OF EXTRACTS OF THE SUPRARENAL CAPSULES. BY GEORGE OLIVER, M.D., AND E. A. SCHAFER, F.R.S.(From the Physiological Laboratory, University College.), J. Physiol, June 24, 1895. • AN EXPERIMENTAL RESEARCH INTO THE RESUSCITATIONOF DOGS KILLED BY ANESTHETICS AND ASPHYXIA. BY GEORGE CRILE, M.D., AND DAVID H. DOLLEY, M.D., J. Exp Med, 1906 • Intravenous Drug Administration during out-of-hospital cardiac Arrest, A randomized controlled trial, T M Olasveengen et al; JAMA. 2009; 302 (20): 2222-2229 • Epinephrineforcardiac arrest, CW Callaway; CurrOpinCardiol 2013 Jan;28(1):36-42 • Effects of sustained abdominal aorta compression on coronary pefusion pressures and restoration of spontaneous circulation during CPR in swine, Manhong Zhou et al; Resuscitation 82 (2011) 1087-1091

  31. Objet d’arte

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