Emergency medicine residents effectively direct inhospital cardiac arrest teams.

STUDY OBJECTIVE: We compared 2 models of physician leadership for inhospital cardiac arrest teams (CATs): emergency medicine (EM) residents and staff hospitalist physicians. METHODS: A before-after study was conducted on all adult inhospital CAT activations over a 2-year period. The primary outcome was return of spontaneous circulation (ROSC). RESULTS: There were 749 total code blues during the 2-year study period. Ninety-one were excluded by protocol. EM residents directed 288 codes, hospitalists directed 248 codes, and other specialties directed the remaining 62. There was no statistically significant difference in percent ROSC or survival to hospital discharge. EM residents responded first for 59.2% of the codes compared with a first response rate of 28% for hospitalists (P<.05). Time to achieve ROSC was quicker in the EM resident cohort. CONCLUSION: Our findings validate the use of a 24-hour EM resident staffing model for CAT response to inhospital cardiac arrests.

Tenecteplase and return of spontaneous circulation after refractory cardiopulmonary arrest.

Even with the benefit of cardiopulmonary resuscitation, the prognosis of cardiac arrest remains poor. Multiple case series describe survival with the use of thrombolytic therapy for refractory cardiac arrest. Presumably thrombolysis treats that subset of cardiac arrest cases resulting from fulminant pulmonary embolism, or perhaps massive myocardial infarctions. Published reports to date have dealt exclusively with streptokinase, urokinase, reteplase, or recombinant tissue plasminogen activator. The authors report the first case of return of spontaneous circulation with the administration of tenecteplase. Tenecteplase is a recently developed reengineered isomer of tissue plasminogen activator that possesses many properties of the ideal cardiac arrest thrombolytic agent. It is bolus dosed, stable at room temperature before reconstitution, and is compatible with most other advanced cardiac life support medications. Because of clinical equivalency and its logistical advantages, tenecteplase should be evaluated as an alternative to other thrombolytics in future trials involving cardiac arrest.

Knee strength after total knee arthroplasty.

Fifty-two knees in normal healthy subjects and 32 knees more than 2 years after total knee arthroplasty (TKA) were evaluated. Average isometric extension peak torque values in TKA patients were reduced by up to 30.7% (P=.01). Isometric flexion peak torque values in patients with TKA were, on average, 32.2% lower than those from control subjects throughout the motion arc (P=.004). Knee Society Functional Scores were positively correlated to the average isometric extension peak torque (r=0.57; P=.004) and negatively correlated to the average isometric hamstring to quadriceps (H/Q) ratio (r=-0.78, P<.0001). Relatively greater quadriceps strength was associated with a better functional score. Older TKA patients (>/=70 years) generated lower isometric extension peak torque values in terminal extension than younger TKA patients (>24.2%; P=.05). Higher body mass index (BMI) was associated with relative quadriceps weakness (r=0.44; P=.007). These results suggest that more thorough rehabilitation after TKA would improve functional outcomes.

Average patient walking activity approaches 2 million cycles per year: pedometers under-record walking activity.

A two-dimensional accelerometer worn on the ankle (step activity monitor [SAM]; Prosthetic Research Study, Seattle, WA) has been proved to be highly accurate for assessing walking activity. The walking activity of 33 patients with well-functioning total hip arthroplasties was measured continuously during daily life, simultaneously with a pedometer and a SAM. The SAM recorded an average of 1.9 million cycles/y. The pedometer under-recorded an average of 34% cycles per day compared with the SAM (P=.0007), but the 2 measures were highly correlated (r=0.66; P=.001). No difference was seen in the number of gait cycles per day between men and women. The previously reported difference in average walking activity between men and women is due to greater under-recording of the pedometer in women, especially those with a body mass index > or =27. The pedometer is more reliable in quantifying the walking activity of men, less obese women, and patients with >1 million gait cycles/y.