Papers by Richard Cummins
Prehospital and Disaster Medicine, 1994
Objective:To assess the accuracy of paramedic estimates of adult body weights in cardiac arrest c... more Objective:To assess the accuracy of paramedic estimates of adult body weights in cardiac arrest cases.Hypothesis:Paramedics could accurately estimate the weights of out-of-hospital cardiac arrest patients.Design:Retrospective data analysis of a 15-month, multicenter study involving nontraumatic out-of-hospital cardiac arrest patients. Paramedic estimates of body weights were compared to weights measured in the hospital. Patients were included in the analysis only if both a paramedic weight and a measured in-hospital weight were recorded.Setting:Six urban emergency medical services systems.Participants:The study population included adults with return of spontaneous circulation who subsequently were admitted to the hospital.Measurements:Pearson correlation analysis of paramedic-estimated weights and measured weights.Results:Among the 133 study patients, the correlation coefficient (R) for paramedic estimates and the actual measured weight was 0.93. Paramedic estimates of weight were w...
Journal of the American College of Cardiology, 1988
A library of arrbytbmiss obtabwd irom patient, with cardiac arrest was devetopcd. Such il data ba... more A library of arrbytbmiss obtabwd irom patient, with cardiac arrest was devetopcd. Such il data base nil, permir both in *it,0 testing a, Ibe rbhy,brn analyrir IyItPln al ~utanatic external deribr,,l.,ars before clinical tietd trials are ronduct& and comparison of devices. Defibrillators equipped with voicilecfr~ardiogrspht tape recorders and used in tbr prehospib, defibrtllatiw programs in !owa and King County, Wasbin&," provided the rhythm YIWPL. From these remrdiny, wgmene or v~ntrkular tibrilbtian with minima, srtthct and P duration of 16 I wres&s,ed.
Arquivos Brasileiros de Cardiologia, 2006
Annals of Internal Medicine, 1990
This study of 110 patients (aged 65 and older) indicates that cardiopulmonary resuscitation is as... more This study of 110 patients (aged 65 and older) indicates that cardiopulmonary resuscitation is as feasible in the patient with pulmonary disease as it is in the patient with cardiac disease. This applies particularly to the elderly. Early recognition of pulmonary insufficiency in elderly patients may be delayed because of concomitant multiple disease. Yet treatment must be started promptly and intensively if resuscitation is to be successful. Those who treat these patients must have wide experience with respiratory disease and must be intelligent, alert and constant in their attendance. This phase of medical care is truly a team effort,
Annals of Emergency Medicine, 2000
Background Whether antiarrhythmic drugs improve the rate of successful resuscitation after outof-... more Background Whether antiarrhythmic drugs improve the rate of successful resuscitation after outof-hospital cardiac arrest has not been determined in randomized clinical trials. Methods We conducted a randomized, doubleblind, placebo-controlled study of intravenous amiodarone in patients with out-of-hospital cardiac arrest. Patients who had cardiac arrest with ventricular fibrillation (or pulseless ventricular tachycardia) and who had not been resuscitated after receiving three or more precordial shocks were randomly assigned to receive 300 mg of intravenous amiodarone (246 patients) or placebo (258 patients). Results The treatment groups had similar clinical profiles. There was no significant difference between the amiodarone and placebo groups in the mean (±SD) duration of the resuscitation attempt (42±16 and 43±16 minutes, respectively), the number of shocks delivered (4±3 and 6±5), or the proportion of patients who required additional antiarrhythmic drugs after the administration of the study drug (66 percent and 73 percent). More patients in the amiodarone group than in the placebo group had hypotension (59 percent vs. 48 percent, P=0.04) or bradycardia (41 percent vs. 25 percent, P=0.004) after receiving the study drug. Recipients of amiodarone were more likely to survive to be admitted to the hospital (44 percent, vs. 34 percent of the placebo group; P=0.03). The benefit of amiodarone was consistent among all subgroups and at all times of drug administration. The adjusted odds ratio for survival to admission to the hospital in the amiodarone group as compared with the placebo group was 1.6 (95 percent confidence interval, 1.1 to 2.4; P=0.02). The trial did not have sufficient statistical power to detect differences in survival to hospital discharge, which differed only slightly between the two groups. Conclusions In patients with out-of-hospital cardiac arrest due to refractory ventricular arrhythmias, treatment with amiodarone resulted in a higher rate of survival to hospital admission. Whether this benefit extends to survival to discharge from the hospital merits further investigation.
American Journal of Roentgenology, 1980
Richard 0. Cummins was a Robert Wood Johnson Clinical Scholar and is currently a Milbank Memorial... more Richard 0. Cummins was a Robert Wood Johnson Clinical Scholar and is currently a Milbank Memorial Fund Scholar. The opinions, statements, and analyses contamed in this report are those of the author alone, and may not reflect the views of the Robert Wood Johnson Foundation; nor the Departments of General Surgery and Radiology at the University of Washington, which cooperated with this study.
American Journal of Public Health, 1985
We initiated a program of telephone CPR (cardiopulmonary resuscitation) instruction provided by e... more We initiated a program of telephone CPR (cardiopulmonary resuscitation) instruction provided by emergency dispatchers to increase the percentage of bystander-initiated CPR for out-of-hospital cardiac arrest. Cardiac arrests in King County, Washington were studied for 20 months before and after the telephone CPR program began. Bystander-initiated CPR increased from 86 of 191 (45 per cent) cardiac arrests before the program to 143 of 255 (56 per cent) cardiac arrests after the program. During the after period, 58 patients received CPR as a result of telephone instruction, 12 of whom were discharged. We estimate that four lives may have been saved by the program. A review of hospital records revealed no excess morbidity in the group of patients receiving dispatcher-assisted CPR.
Annals of Noninvasive Electrocardiology, 1997
Resuscitation, 2000
The pulse check, under scrutiny by a number of researchers in the 1990s, is in reality a diagnost... more The pulse check, under scrutiny by a number of researchers in the 1990s, is in reality a diagnostic test. 8 -23 Circulation. 2000;102(suppl I):I-377-I-379.
New England Journal of Medicine, 1993
Annals of Emergency Medicine, 1995
American Journal of Emergency Medicine, 1989
This study was conducted to determine the feasibility of recruitment of lay persons to use automa... more This study was conducted to determine the feasibility of recruitment of lay persons to use automatic external defibrillators (AEDs), the effectiveness of their initial training, and the need for and frequency of retraining over time. Volunteers (n = 146), recruited from a variety of settings, included security personnel and administrative staff from large corporate centers, supervisors from senior care and exercise facilities, and employees in high-rise office buildings. Seven sites for 14 AEDs were recruited. In a single, two-hour class, participants learned to identify and respond to cardiac arrest, to notify emergency personnel, to retrieve and attach the semiautomatic (shock advisory) AED, and to respond to instructions presented on the display screen of the device. A skills check list was used to grade each student on performance of cardiopulmonary resuscitation, operation of the device, and time required to deliver an electric countershock. Retesting was performed one or more times after initial training to assess skill retention. The study lasted 1 year. All age groups, both sexes, and each responder type easily learned to operate the AED, with a trend for lower performance scores in people aged greater than 60 years. Performance time and skills declined significantly after initial training, but returned to satisfactory levels after one retraining session and were even higher after two retraining sessions. With retesting, errors that would have prevented delivery of countershocks to patients in ventricular fibrillation were rare (six of 146 tests, 4%). During the year of this study only three cardiac arrests occurred in the study sites.(ABSTRACT TRUNCATED AT 250 WORDS)
American Journal of Emergency Medicine, 1991
This study demonstrates the effect of different denominators on the survival rate from out-of-hos... more This study demonstrates the effect of different denominators on the survival rate from out-of-hospital cardiac arrest. We retrospectively analyzed data from a cardiac arrest surveillance system in King County, Washington during the years 1976 to 1988, and calculated survival rates using eight different definitions of denominators. The eight survival rates ranged from 16% to 49% discharge from hospital. The denominator for the lowest survival rate included all cases of cardiac arrest for whom emergency medical services personnel started cardiopulmonary resuscitation. The denominator for the highest survival rate included: all cases of presumed cardiac etiology; first recorded rhythm was ventricular fibrillation; collapse witnessed; cardiopulmonary resuscitation started by bystanders within 4 minutes; and definitive care provided within 8 minutes. The definition of cases included in the denominator can dramatically effect the resultant survival rate. There must be national and international agreement about definitions of denominators for valid cross community comparisons.
American Journal of Emergency Medicine, 1986
The authors retrospectively studied victims of sudden cardiac death who experienced cardiac arres... more The authors retrospectively studied victims of sudden cardiac death who experienced cardiac arrest before and after arrival of emergency personnel in order to define possible etiologic factors. There were 265 patients in the arrest-after-arrival (AAA) group and 414 patients in the arrest-before-arrival (ABA) group. All patients in the AAA group had symptoms prior to cardiac arrest. Approximately half the patients in the ABA group had symptoms. The presence or absence of symptoms prior to cardiac arrest appeared strongly associated with the cardiac rhythm at time of collapse and with discharge. Of patients with symptoms, 61% were in ventricular fibrillation or ventricular tachycardia, as compared with 93% of patients without symptoms (P < 0.001); 32% of patients with symptoms were discharged, as compared with 57% of patients without symptoms (P < 0.001). These data suggest two potential etiologies for sudden cardiac arrest; thrombosis/ischemia (associated with symptoms) and electrical (associated with no symptoms). Inasmuch as the AAA group represented 14% of witnessed cardiac arrests, patients with symptoms of myocardial ischemia or infarction should be aggressively treated.
Resuscitation, 1997
The aim of this report is to establish recommendations for reviewing, reporting, and conducting r... more The aim of this report is to establish recommendations for reviewing, reporting, and conducting research during the post-resuscitation period in hospital. It defines data that are needed for research and more specialised registries and therefore supplements the recently updated Utstein template for resuscitation registries. The updated Utstein template and the out-of-hospital ''Chain of Survival'' describe factors of importance for successful resuscitation up until return of spontaneous circulation (ROSC).
Uploads
Papers by Richard Cummins