Brain is an extremely vulnerable organ to hypoxiaischemia. Because of its poor regenerative ability, brain resuscitation has been an extremely difficult challenge. However, energetic research revealed several secondary events are involved in the development of central nervous system damage, including post-resuscitation reperfusion failure (no-reflow, delayed hypo-perfusion), metabolic-biochemical events (excitotoxicity, disturbance in calcium homeostasis, free radicals), and changes in death-or survival signal transduction in relation to genes/proteins (apoptosis) . Some neurons were found to exhibit process of delayed neuronal death, which means there is therapeutic time window. This review will attempt to make a historical overview of the brain resuscitation.

View full abstract

International Liaison Committee on Resuscitation (ILCOR) promulgated and published 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations in November 2005 after vigorous evidence evaluation process, which included reviewing 2000 Guidelines, proposal statement, evidence gathering, evaluation and classification, worksheet summarization, and consensus meeting. The American Heart Association (AHA) and European Resuscitation Council (ERC) published their guidelines on resuscitation simultaneously with the international consensus publication. Japanese Committee on CardiopulmonaryResuscitation started discussing new guidelines after the publication of ILCOR consensus and AHA/ERC guidelines, and published its guidelines recently. ILCOR already embarked on evidence evaluation process for consensus 2010. Japan Resuscitation Council (JRC) as a leading member of Resuscitation Council of Asia (RCA) is desired to significantly contribute to Consensus 2010.

View full abstract

The causes of incidence and the treatment methods for the intermittent CO poisoning in the last 20 years in japan were analyzed. After treatments with only NBO for acute CO poisoning without pathological findings, unusual findings in the CT/MRI had been observed rather than HBOT in the intermittent CO poisoning induced later. Therefore, the HBOT should be performed for treatment of CO poisoning.

View full abstract

At our facility, training in ICLS (Immediate Cardiac Life Support) was provided on very many occasions to staff members, although the rate of survival to hosipital discharge could not be increased despite such efforts. We have therefore begun providing training in BLS (basic life support) to all nurses working at our hospital, and all nurses have completed the training course. To facilitate use of BLS in daily clinical practice, the nurses attending the BLS training were instructed to practice CPR (cardiopulmonary resuscitation) by means of chest compression until a bag-valve mask (BVM) arrives for use. To facilitate recall of what has been learned, it seems essential to present lectures in as simple a fashion as possible in educating adults. Although the length of time from detection of collapse of patients to the call for help was not shorter after this training than before it, patients discharged in good condition began to be seen after the training, though no such patient had been seen before it. This appears to reflect improvement in quality of basic CPR procedures. BLS is easier to learn than ICLS for many nurses working at our hospital. This training is thus promising as a means of improving the outcome of care for critical patients.

View full abstract

We report a case of pulmonary thromboembolism (PTE) following tourniquet inflation for lower extremity surgery. A 72 years old woman who was scheduled for surgical fixation of left patella fracture had been standing by at home for 8 days until operation. Her suffered knee had been fixed with a knee brace which allowed patients to move their ankles to prevent deep vein thrombosis. Induction of general anesthesia was uneventful. Arterial blood pressure, peripheral oxygen saturation and end-tidal carbon dioxide partial pressure dropped suddenly after tourniquet inflation. Immediately 5000 units of heparin were injected intravenously, then these parameters were improved.
The operation was cancelled and the patient was transferred to the highly equipped hospital for intensive care next day. Diagnosis of PTE was made by multi-slice computed tomography. Inferior vena cava filter was inserted and anticoagulant therapy (heparin and warfarin) was started. Two weeks later, the operation was undergone safely. At the moment, it is difficult to prevent PTE completely in orthopedic surgical patients. On suspicion of PTE, both the immediate administration of heparin to inhibit the further thrombus formation and the transportation of the patient to a highly equipped hospital could save the patient's life.

View full abstract

An early cardiopulmonary resuscitation and an early defibrillation capability by all staff in hospital are essential. The statcall committee was established in our hospital in April, 2004.
There were twenty-one emergency call (statcall) cases in the first 11 months: 11 asystole, six ventricular tachycardia or ventricular fibrillation, and four consciousness disturbance. Eighteen of these cases occurred in ward, two occurred in outpatient clinic, and one occurred in a radiological laboratory room. The results were eight revivals and thirteen deaths. Automated external defibrillators (AEDs) were used in 12 cases and were instrumental in reviving four patients. One of them was an 84-year-old in-hospital female patient who suffered from an episode of ventricular fibrillation in the coronary care unit. Using AED, a nurse delivered electrical shock to revert the ventricular fibrillation, and succeeded in restoring the patient's circulation before the arrival of a physician.
We took a training course of a basic life support and how to use AED every month for all staff in our hospital. It is very important that all staff in the hospital is skilled to save a patient in cooperation in a common manner. And the director of our hospital ordered that in a hospital emergency, every employee having taken a training course do basic life support using AED.

View full abstract