Background. There are two competing theories of the mechanism of blood flow during cardiopulmonary resuscitation. The "cardiac pump" theory postulates that blood flows because the heart is squeezed between the sternum and the spine. The "thoracic pump" theory postulates that blood flows from the thorax because intrathoracic pressure exceeds extrathoracic vascular pressure and that flow is restricted to the venous-to-arterial direction because of venous valves that prevent retrograde flow at the thoracic inlet. To determine which mechanism is operative during actual cardiopulmonary resuscitation, 20 patients were imaged with transesophageal echocardiography during resuscitation.Methods and Results. Transesophageal two-dimensional and pulse Doppler echocardiography was begun within 7 minutes of initiation of cardiopulmonary resuscitation. In the 18 patients who could be analyzed, the mitral valve opened during the release phase (diastole) and closed during the compression phase
ACD CPR is a simple manual technique that improved cardiopulmonary circulation in 10 patients during cardiac arrest. Although ACD CPR may have produced a return of spontaneous circulation in three patients refractory to standard measures, its impact on survival when used early in cardiac arrest remains to be determined.
The correlation between pre-dialysis serum albumin and mortality has been linked with malnutrition. We measured pre and post-dialysis albumin in 86 stable haemodialysis patients and compared them with anthropometric measurements and body mass index (BMI). On the basis of pre-dialysis albumin 13% of patients would be classified as high risk, whilst on the basis of post-dialysis albumin only 12% would be classified as high risk. Change in albumin could be predicted by fluid removal during haemodialysis. Pre-dialysis albumin correlated weakly with mid upper arm circumference (MUAC). Post dialysis albumin correlated with MUAC and triceps skin fold thickness (TSF). There was a weak negative correlation between age and post-dialysis albumin. TSF strongly correlated with MUAC and BMI. Pre-dialysis albumin appears to be a poor predictor of nutritional status and does not correlate well with other nutritional parameters. The excess risk of death associated with a low pre-dialysis albumin may be related to fluid overload rather than malnutrition.
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