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Editorials Cardiopulmonary-cerebral Resuscitation in the Hospital The specialty of emergency medicine has continued to build its data base in the field of cardiopulmonary- cerebral resuscitation research at both the basic science and clinical levels. This was evident at the 1984 Purdue Conference on CPR and Defibrillation and at the 1984 ACEP Winter Symposium held in Phoenix Arizona that was devoted to this topic. The papers presented at these meetings have been pub- lished in the emergency medicine literature.‘,1 Fol- lowing this, emergency physicians presented papers and played a significant part in the 1985 UA/EM- IRIEM resuscitation research symposium held in Florida.3 It is increasingly apparent that emergency medicine’s expertise in this area is becoming more recognized by others in medicine. This has resulted in formal input by emergency physicians into the cardio- pulmonary resuscitation committees of many hos- pitals in the United States. At the May 1985 meeting of the University Associa- tion for Emergency Medicine, a special session was held to determine the interest of emergency physi- cians chairing CPR committees in developing collabo- rative efforts in both the mechanics of code response and in data accumulation and analysis. The inaugural meeting was a standing-room-only affair for the nu- merous emergency physicians who chaired their hos- pitals’ CPR committees and a host of spectators who were interested in the topic and emergency medicine’s role in it. The session was interesting and dynamic. Many realized that they face similar problems, and so- lutions were proposed that were varied and innova- tive. A sharing of this information was thought to be helpful to all those who attended. The group agreed to share information with one an- other regarding reporting forms, data systems, quality assurance programs, policies and procedures, etc. In addition, a longer-term goal endorsed by this group was to develop a common reporting form in many in- stitutions that could serve as a basis for data compar- ison and multicenter collaborative research. The group of CPR committee chairmen plans to meet yearly in conjunction with the annual UA/EM meeting, and it is hoped that the initial interest shown will attract many more individuals. The co-chairmen of this committee believe that an increasing utilization of emergency physicians as chairman of the in-hospital CPR committees attests to the increasing acceptance of emergency medicine and its areas of expertise by others in medicine. It is only natural and appropriate that this trend continue. We welcome all participation to aid us in this endeavor. MICHAEL KOBERNICK. MD William Beaumont Hospital RICHARDM. NOWAK, MD Henty Ford Hospital Detroif References 1. Cardiopulmonary-cerebral resuscitation: state of the art. Ann Emerg Med 1984;13:775-875. 2. Proceedings of the Fifth Purdue Conference on CPR and Defibrillation. Am J Emerg Med 1985;3:99-174. 3. Proceedings of the 1985 UAEM/IRIEM research symposium on resuscitation. Ann Emerg Med 1985;14:712-821. Catecholamines and Calcium Blockers in Cardiac Resuscitation At the recent American Heart Association Confer- ence on CPR standards, it was agreed that calcium should be dropped from resuscitation protocols but, lacking sufftcient evidence to the contrary, that epi- nephtine should be retained.‘.2 In fact, we now know that calcium treatment is ineffective except in cardiac arrest associated with hyperkalemia or calcium blocker overdose. These new recommendations con- cerning calcium are in accord with recent evidence suggesting that calcium blockers may well have a role in resuscitation and prevention of reperfusion injury.3 How calcium blocking agents exert this protective ef- fect is not widely understood. Recent developments in several fields suggest that at least part of the mecha- nism involves protecting the myocardium from the ef- fects of endogenous and exogenous catecholamines. 189

Cardiopulmonary-cerebral resuscitation in the hospital

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Editorials

Cardiopulmonary-cerebral Resuscitation in the Hospital

The specialty of emergency medicine has continued to build its data base in the field of cardiopulmonary- cerebral resuscitation research at both the basic science and clinical levels. This was evident at the 1984 Purdue Conference on CPR and Defibrillation and at the 1984 ACEP Winter Symposium held in Phoenix Arizona that was devoted to this topic. The papers presented at these meetings have been pub- lished in the emergency medicine literature.‘,1 Fol- lowing this, emergency physicians presented papers and played a significant part in the 1985 UA/EM- IRIEM resuscitation research symposium held in Florida.3 It is increasingly apparent that emergency medicine’s expertise in this area is becoming more recognized by others in medicine. This has resulted in formal input by emergency physicians into the cardio- pulmonary resuscitation committees of many hos- pitals in the United States.

At the May 1985 meeting of the University Associa- tion for Emergency Medicine, a special session was held to determine the interest of emergency physi- cians chairing CPR committees in developing collabo- rative efforts in both the mechanics of code response and in data accumulation and analysis. The inaugural meeting was a standing-room-only affair for the nu- merous emergency physicians who chaired their hos- pitals’ CPR committees and a host of spectators who were interested in the topic and emergency medicine’s role in it. The session was interesting and dynamic. Many realized that they face similar problems, and so- lutions were proposed that were varied and innova-

tive. A sharing of this information was thought to be helpful to all those who attended.

The group agreed to share information with one an- other regarding reporting forms, data systems, quality assurance programs, policies and procedures, etc. In addition, a longer-term goal endorsed by this group was to develop a common reporting form in many in- stitutions that could serve as a basis for data compar- ison and multicenter collaborative research. The group of CPR committee chairmen plans to meet yearly in conjunction with the annual UA/EM meeting, and it is hoped that the initial interest shown will attract many more individuals.

The co-chairmen of this committee believe that an increasing utilization of emergency physicians as chairman of the in-hospital CPR committees attests to the increasing acceptance of emergency medicine and its areas of expertise by others in medicine. It is only natural and appropriate that this trend continue. We welcome all participation to aid us in this endeavor.

MICHAEL KOBERNICK. MD William Beaumont Hospital RICHARD M. NOWAK, MD Henty Ford Hospital Detroif

References

1. Cardiopulmonary-cerebral resuscitation: state of the art.

Ann Emerg Med 1984;13:775-875.

2. Proceedings of the Fifth Purdue Conference on CPR and Defibrillation. Am J Emerg Med 1985;3:99-174.

3. Proceedings of the 1985 UAEM/IRIEM research symposium

on resuscitation. Ann Emerg Med 1985;14:712-821.

Catecholamines and Calcium Blockers in Cardiac Resuscitation

At the recent American Heart Association Confer- ence on CPR standards, it was agreed that calcium should be dropped from resuscitation protocols but, lacking sufftcient evidence to the contrary, that epi- nephtine should be retained.‘.2 In fact, we now know that calcium treatment is ineffective except in cardiac arrest associated with hyperkalemia or calcium blocker overdose. These new recommendations con-

cerning calcium are in accord with recent evidence suggesting that calcium blockers may well have a role in resuscitation and prevention of reperfusion injury.3 How calcium blocking agents exert this protective ef- fect is not widely understood. Recent developments in several fields suggest that at least part of the mecha- nism involves protecting the myocardium from the ef- fects of endogenous and exogenous catecholamines.

189