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עמוד בית
Wed, 28.02.24

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March 2007
M. Gordon
Cardiopulmonary resuscitation is an emotion-ridden issue that often leads to conflicts when crucial decisions have to be made. The purported benefits of this 40 year old procedure in the frail elderly have been scrutinized, establishing its lack of efficacy. A review of the medical, ethics and halakhic* literature on the potential merits of CPR[1] in the frail elderly revealed that in secular medical practice, CPR is often routinely provided to elderly frail individuals for whom its clinical benefit is questionable. For patients suffering from dementia, surrogates are usually responsible for decision making, which complicates the process. With such poor clinical outcomes, the halakhic interpretation of what steps should be taken, and currently are, may not be valid and CPR may be applied too frequently. When clinical ambiguity is combined with strong cultural and religious influences, an acceptable CPR/DNR (Do Not Resuscitate) approach to cardiac arrest can be daunting. A clinically responsible, ethically sound and religiously sensitive approach to CPR requires a deep understanding of the factors involved in decision making. It seems timely for the halakhic interpretation of the duty to provide CPR in the frail elderly to be reevaluated. Perhaps a more humane and halakhically sound approach might be reached by stringently limiting CPR to clinically unusual circumstances rather than the common practice of providing frail Jewish elders with CPR in the absence of a DNR order.





* Pertaining to Halakha, the corpus of Jewish law


[1] CPR = cardiopulmonary resuscitation


October 2005
Y. Waisman, L. Amir, M. Mor and M. Mimouni.
 Background: The Pediatric Advanced Life Support course of the American Heart Association /American Academy of Pediatrics was established in Israel in 1994 and has since been presented to over 3,108 medical and paramedical personnel.

Objectives: To assess the achievements of participants in the PALS[1] course, as a cohort and by professional group, and their evaluations of different aspects of the course; and to describe the educational modifications introduced to the course since its introduction in Israel on the basis of our teaching experience.

Methods: The study sample consisted of physicians, nurses and paramedics from all areas of Israel who registered for PALS between January 2001 and December 2003. Participants took a standardized test before and after the course; a score of 80 or higher was considered a pass. On completion of the course, participants were requested to complete a 24-item questionnaire evaluating the quality of the course as a whole, as well as the lectures, skill stations, and instructors’ performance. Items were rated on a 5-point scale. Results were analyzed using the BMPD statistical package.

Results: Altogether, 739 subjects participated in 28 courses: 13 attending (in-hospital) physicians (1.8%), 89 community pediatricians (12%), 124 residents (16.8%), 304 nurses (41.1%), and 209 paramedics (28.3%). About half (48.9%) were hospital-based, and about half (47.9%) had no experience in emergency medicine. A passing grade was achieved by 89.4% of the participants; the mean grade for the whole sample was 87.2%. The mean test score of the residents was significantly better than that of the nurses (P < 0.05) and pediatricians (P < 0.01). The median evaluation score for four of the five stations was 5, and the mean overall score for all items was  4.56 (range by item 3.93–4.78).

Conclusions: PALS was successfully delivered to a large number of healthcare providers in various professional groups with very good overall achievements and high participant satisfaction. It significantly increased participants’ knowledge of pediatric resuscitation. We therefore recommend the PALS course as an educational tool in Israel.


 





[1] PALS = Pediatric Advanced Life Support


September 2005
E. Kaluski, N. Uriel, O. Milo and G. Cotter
 Although 40 years have passed since the advent of advanced cardiac life support, out-of-hospital cardiac arrest still carries an ultimate failure rate of 95%. This review reinforces the importance of public education, optimization of the local chain of survival, early bystander access and bystander basic life support, and early defibrillation. It emphasizes the role of simplified basic life support algorithms and demonstrates the low incremental benefit of complex skillful protocols employed in ACLS[1]. The impact of automatic external defibrillators and new medications incorporated into ACLS algorithms is evaluated in the light of contemporary research. The persistent, discouraging, low functional survival rate (less than 5% of out-of-hospital cardiac arrest victims) mandates reassessment of current strategies and guidelines.

_________________

[1] ACLS = advanced cardiac life support

 
April 2003
R. Ben-Abraham, E. Hadad, A.A. Weinbroum, O. Efrat and G. Paret

Vasopressin is a potent endogenous vasoconstrictor that increases blood pressure and systemic vascular resistance. The administration of exogenous vasopressin during closed and open cardiopulmonary resuscitation in humans was shown to be more effective than optimal doses of epinephrine in several clinical studies. We summarize here the recent experimental and clinical data on the use of vasopressin in cardiopulmonary resuscitation and septic shock. As the use of vasopressin in human resuscitation is now in its early stages, it is expected that accumulated future experience will shed more light regarding the risk-benefit aspects of its use.

February 2002
Eilon Shany, MD, David Greenberg, MD and Eliezer Shahak, MD
September 2000
Arnon Broides MD, Shaul Sofer MD and Joseph Press MD

Background: The outcome of cardiopulmonary arrest in children is poor, with many survivors suffering from severe neurological defects. There are few data on the survival rate following cardiopulmonary arrest in children who arrived at the emergency room without a palpable pulse.

Objective: To determine the survival rate and epidemiology of cardiopulmonary arrest in children who arrived without a palpable pulse at a pediatric ER in southern Israel.

Methods: We retrospectively reviewed the medical records of all patients with cardiopulmonary arrest who arrived at the ER of the Soroka University Medical Center during the period January 1995 to June 1997.

Results: The study group included 35 patients. Resuscitation efforts were attempted on 20, but the remaining 15 showed signs of death and were not resuscitated. None of the patients survived, although one patient survived the resuscitation but succumbed a few hours later. The statistics show that more cardiopulmonary arrests occurred among Bedouins than among Jews (32 vs. 3, P0.0001).

Conclusions: The probability of survival from cardiopulmonary arrest in children who arrive at the emergency room without palpable pulse is extremely low. Bedouin children have a much higher risk of suffering from out-of-hospital cardiopulmonary arrest than Jewish children.

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