The purpose of this study was to investigate a resuscitation algorithm that calculates the value of AMSA in real-time to direct the duration of post-shock chest compressions. We hypothesized that such an algorithm would shorten the time to achieve ROSC in swine. Swine were randomized into normal or infarcted myocardia and waveform guided or traditional resuscitation algorithm groups. VF was induced electrically and left untreated for 10minutes. Resuscitation was commenced with 1minute of compressions, resumption of mechanical ventilation, shock and epinephrine. In the traditional group, all shocks were followed by 2minutes of post-shock compressions. In the waveform guided group, AMSA was measured prior to shocks. If AMSA>20mV-Hz, post shock compression duration was shortened to 1minute.This study found that the waveform guided resuscitation algorithm to direct the duration of post-shock chest compressions had no significant effect on time to ROSC or AMSA values when compared to the traditional resuscitation algorithm.

The Analysis of Ilan¡¦s Out-of-Hospital Cardiac Arrest (OHCA) Patients Abstract The study uses Ilan¡¦s out-of-hospital cardiac arrest (OHCA) patients as the research object to understand the variable backgrounds of OHCA patients how they are affected by first aid factors between the period of pre-hospital and post-hospital admission. The study also discusses whether there is a correlation between first aid factors and first aid prognosis among those OHCA patients during pre-hospital and post-hospital admission periods. The study is retrospective and based on the Utstein style format. It collects 284 out-of-hospital cardiac arrest (OHCA) patient cases with trauma and non-trauma (282 effective samples) in an example of a regional teaching hospital in Ilan from 2007 to 2009. It uses descriptive statistics, independent sample t test, and Chi-Square test as the statistical analysis to obtain the following conclusions: 1. There are 282 effective sample patients in the study. There are 57 patients ( 20.2 %) who were return of spontaneous circulation (ROSC) after cardiac arrest approximately 14.77 minutes on average. There are 33 patients (11.7 % ) who survived to be hospitalized for 15.36 days on average, and there are 6 patients ( 2.1 % ) who were discharged from the hospital. 2. Internal medicine disease is the major causative factor of out-of-hospital cardiac arrest. Among those internal medicine disease cases, the history showed hypertension, diabetes mellitus, and heart diseases are the main causes of out-of-hospital cardiac arrest. Patients who are older than 65 years old are the main age groups, accounting for 67.7% of these cases. 3. The pre-hospital admission factors which affect the prognosis after the Emergency Department (ED) are the place of the accident, whether there are witnesses, scene process time , total reaction time , whether automatic external defibrillation was used, and whether people at the scene used CPR. 4. The post-hospital admission factors which affect the prognosis after the ED are initial cardiac rhythm, body temperature, pupil size , dose of epinephrine, whether defibrillation was used, the time of applying emergency first-aid, and medical expense. 5. The percentages of return of spontaneous circulation and survival rates in the study are lower than those of past studies of Taipei City and National Taiwan University Hospital. The possible factors are probably related to differences between rural and urban areas in the quality of emergency medical service systems (EMSS), and healthcare training. 6. From now on, in addition to improving the first-aid continuous monitoring system, we should also enhance EMT related training, and actively educate people to understand and learn CPR, so that comprehensive first-aid systems are available everywhere to effectively increase the success rate of first-aid. Keywords¡GOut-of-hospital cardiac arrest (OHCA), Cardiopulmonary resuscitation

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It is a major clinical problem that survival rates after out-of-hospital cardiac arrest have not markedly improved during the last decades, despite extensive research and the introduction of new interventions. However, recent studies have demonstrated promising treatments such as targeted temperature management (TTM) and methylene blue (MB). In our first study, we investigated the effect of MB administered during experi-mental cardiopulmonary resuscitation (CPR) in the setting of postponed hypother-mia in piglets. We set out to study if MB could compensate for a delay to establish targeted TTM. The study demonstrated that MB more than compensated for 30 min delay in induction of TTM. The effect of MB added to that of TTM. The second study examined the effects of TTM and S-PBN on the endothelin system and nitric oxide synthases (NOS) after prolonged CA in a porcine CPR mod-el. The study was designed to understand the cardioprotective mechanism of S-PBN and TTM by their influence on the endothelin system and NOS regulation. We veri-fied for the first time, that these two cardioprotective postresuscitative interventions activate endothelin-1 and its receptors concomitantly with eNOS and nNOS in the myocardium. We concluded that nitric oxide and endothelin pathways are implicated in the postresuscitative cardioprotective effects of TTM. The third study compared survival and hemodynamic effects of low-dose amio-darone and vasopressin to vasopressin in a porcine hypovolemic CA model. The study was designed to evaluate whether resuscitation with amiodarone and vasopressin compared to vasopressin alone would have an impact on resuscitation success, survival, and hemodynamic parameters after hemorrhagic CA. We found that combined resuscitation with amiodarone and vasopressin after hemorrhagic circulatory arrest resulted in greater 3-hour survival, better preserved hemodynamic parameters and smaller myocardial injury compared to resuscitation with vasopressin only. In our fourth study we planned to compare hemodynamic parameters between the treatment group (milrinone, esmolol and vasopressin; MEV) and control group (vasopressin only) during resuscitation from prolonged cardiac arrest in piglets. The study was designed to demonstrate if MEV treatment improved hemodynamics or cardiac damage compared to controls. We demonstrated that MEV treatment reduced cardiac injury compared with vasopressin alone.