Lidocaine in out-of-hospital ventricular fibrillation. Does it improve survival?

BACKGROUND: A large proportion of cardiac arrests outside hospital are caused by ventricular fibrillation. Although it is frequently used, the exact role for treatment with lidocaine in these patients remains to be determined. AIM: To describe the proportion of patients with witnessed out-of-hospital cardiac arrest found in ventricular fibrillation who survived and were discharged from hospital in relation to whether they were treated with lidocaine prior to hospital admission. PATIENTS AND TREATMENT: All the patients with out-of-hospital cardiac arrest found in ventricular fibrillation in Göteborg between 1980 and 1992 in whom cardiopulmonary resuscitation (CPR) was initiated by our emergency medical service (EMS). During the observation period, some of the EMS staff were authorized to give medication and some were not. RESULTS: In all, 1,360 patients were found in ventricular fibrillation, with detailed information being available in 1,212 cases (89%). Lidocaine was given in 405 of these cases (33%). Among patients with sustained ventricular fibrillation, those who received lidocaine had a return of spontaneous circulation (ROSC) more frequently (P < 0.001) and were hospitalized alive more frequently (38% vs. 18%, P < 0.01). However, the rate of discharge from hospital did not significantly differ between the two groups. Among patients who were converted to a pulse-generating rhythm, those who received lidocaine on that indication were more frequently alive than those who did not receive such treatment (94% vs. 84%; P < 0.05). However, the rate of discharge did not significantly differ between the two groups. CONCLUSION: In a retrospective analysis comparing patients who received lidocaine with those who did not in sustained ventricular fibrillation and after conversion to a pulse-generating rhythm, such treatment was associated with a higher rate at ROSC and hospitalization but was not associated with an increased rate of discharge from hospital.

Subjective symptoms and well-being differ in women and men after myocardial infarction.

The frequency of subjective cardiac and psychological complaints among men and women a year after a confirmed diagnosis of myocardial infarction (MI) were compared. Among 660 survivors, 595 patients completed mailed questionnaires at home one year after the MI. There were 421 men, mean age 67.1 +/- 10.7 years, and 174 women, mean age 72.1 +/- 10.6 years. Controlling for the significantly higher mean age among the women, the latter more often had a previous history of angina pectoris, 54.6% (P < or = 0.05) versus 42.9%, and heart failure, 24.7% versus 13.5% (P < or = 0.01). Despite these facts, the women were significantly less often referred to CCU, 82.2% versus 91.7% (P < or = 0.05). One year after the MI, controlling for differences in age and co-morbidity, women reported significantly higher frequencies of psychological and psychosomatic complaints, including sleep disturbances. These differences may have clinical implications for diagnosis and treatment of women with coronary heart disease.

Reference values for renal concentrating capacity in children by the desmopressin test.

Reference values are reported for maximal renal concentrating capacity in children using intranasally administered desmopressin. The report is based on 591 tests in 473 healthy children aged 0.5-13 years. The concentrating capacity increased markedly during the first years of life and reached a plateau at the age of 3 years. The mean value minus two standard deviations was 525 mosmol/kg at 1 year of age and 825 mosmol/kg at 3 years of age.